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HOST FAMILY APPLICATION

①Basic Information
#1 Name of Person Applyingrequired
Genderrequired
Gender 
Date of Birthrequired
Date of Birth 
Age 
Social Security Numberrequired
Home Addressrequired

Street Number/ Street Name, Apt.#
City  State 
Zip Code 
Cell Phone
 -  - 
Home Phone
 -  - 
Email Addressrequired

Confirm
Occupationrequired
Interests/Hobbiesrequired
Referred byrequired
Month and Year You First Became a Host Family?required
How Often do You Host Students?required
Payment Recipient's Name (payable to)required
②Other Household Members
Number of all Household Members (including yourself)required
#2 Name
#2 Name 
Gender 

Date of Birth 
Age 
Social Security Number 
Relationship 
Occupation 
Interests/Hobbies  
#3 Name
#3 Name 
Gender 

Date of Birth 
Age 
Social Security Number 
Relationship 
Occupation 
Interests/Hobbies  
#4 Name
#4 Name 
Gender 

Date of Birth 
Age 
Social Security Number 
Relationship 
Occupation 
Interests/Hobbies  
③Information About Your House
Propertyrequired
House Typerequired
Residence length of current propertyrequired
 years  
Number of room(s) for hostingrequired
Minutes to the closest bus stop by walkrequired

If you know the bus stop number, please write it down.
Any petsrequired

Type of animal 

Stay 
Any Smokers?required
Spoken language(s)required

include all languages spoken in the house

if you speak other language, please write it down
④Food & Amenities
Typical Meal;Breakfastrequired
Typical Meal;Lunchrequired
Typical Meal;Dinnerrequired
Wi-Firequired

free access to Wi-Fi in the home
Additional Amenities
⑤Student's/Participant's Preferences
Meal Planrequired
Genderrequired
Lengthrequired
Smokingrequired
Other