Long Term Host Family

Long Term Host Family Application Form


Please fill out and submit the form below

(Fields marked with an * are mandatory)

Family Name*

Which school will the international students you are interested in hosting attend?

Home Information

Home Address*

City*

State*

Zip Code*

Home Telephone*

# of Bedrooms in Home*

# of Bathrooms in Home*

How far is your home from the school?*

Host Father

Father's Name*

Date of Birth*

Highest Level of Education*

Born in the U.S.*

If No, Country of Birth*

Years in the U.S.

Primary Language*

Secondary Language(if any)

Occupation*

Employer

Work Telephone

Cell Phone

Email*

Host Mother

Mother's Name*

Date of Birth*

Highest Level of Education*

Born in the U.S.*

If No, Country of Birth*

Years in the U.S.

Primary Language*

Secondary Language(if any)

Occupation*

Employer

Work Telephone

Cell Phone

Email*

Primary Contact

Can we share your cell phone numbers with other hosts in your area to assist with student gatherings, carpooling, etc?

Children

Do you have any children? *


Other In-Home Residents

Do you have other in-home residents (exchange students, renters, family members, etc.) *


Pets

Do you have any pets at home? *


Religion

Host Mother

Host Father

Schedule and Hobbies

International students who apply for home stay look forward to spending time with their host family in the evenings and on weekends. Host families are expected to involve students in family activities, outings and events, which will familiarize students with American culture and will help them to feel at ease with your family and your home.

Please give a general description of your family's normal daytime routine and evening/weekend commitments (family activities/religious practices etc):

Weekday

Weekend

What kind of leisure activities can you offer to a student?

Eating Habit

Do you have any special dietary practices or restrictions?*

Household

Do any of your family members smoke?*

Do you have wifi at home?*

Will the student share a bathroom?*

If yes, with whom (please specify the gender): *

Student's bedroom:

What furniture is provided in the bedroom*
 closet dresser desk chair lamp
Others:

Has windows? *

Where is it located in your house? *

Please list any recreational equipment in your house or backyard (for example: piano, guitar, table tennis, trampolines, board games, swimming pool etc)*

Others

Have you ever hosted an Exchange Student?

Which Program(s)

For how long:

Describe your expectations regarding the responsibility and behavior of the student while in your home.(e.g. homework, chores, communications, activities, etc.)

Do you have any preference regarding the gender of your host student(s)?*

How many students would you like to host?*

What type of transportation will be provided to and from school? If school buses service your area, students are allowed to take them.*
 Host family will drive by using private car
 School bus
 Car pool
Others:

Message for the students

Where did you hear about us?

Photos*

Please email us the listed photos to hostfamily.iperc@gmail.com

  1. 1) A recent family photo
  2. 2) Front view of the home
  3. 3) Back view of the home
  4. 4) A picture of the yard (if you have one)
  5. 5) Living room
  6. 6) Kitchen
  7. 7) Dining area
  8. 8) Student’s bedroom
  9. 9) Bathroom the student would use
  10. 10) Pet snapshot (of each pet if you have them)
  11. 11) More photos to help us know more about your house and your family

Agreement*