BIG Host Family Application

Other Occupants

List all persons in the home other than the listed above
OCCUPANT 1

First NameLast Name
Age
Age
Date of birth

MonthDayYear
Date
Gender
Occupation
Primary Language
OCCUPANT 2

First NameLast Name
Age
Age
Date of birth

MonthDayYear
Date
Gender
Occupation
Primary Language
OCCUPANT 3

First NameLast Name
Age
Age
Date of birth

MonthDayYear
Date
Gender
Occupation
Primary Language
OCCUPANT 4

First NameLast Name
Age
Age
Date of birth

MonthDayYear
Date
Gender
Occupation
Primary Language
OCCUPANT 5

First NameLast Name
Age
Age
Date of birth

MonthDayYear
Date
Gender
Occupation
Primary Language
Does anyone living at home have any chronic conditions (physical or mental) that might affect the student? If so please explain.

Host Family Questionnaire
Would you prefer to host

MaleFemale1 Student2 Students
Have you hosted before
Was it a positive experience
Are you willing to volunteer information about the religious affiliation of each family member? Please describe below
Are you willing to host a student that has a different religious affiliation than your family?
* A student can be invited to attend religious based events with the family, but cannot be required to attend. They can determine for themselves if they would like to experience this facet of the U.S. culture. The student should never be made to feel bad for choosing not to participate. They are informed that it is optional, and the family will accept them the same whether they participate or not.
Will you host a student with minor allergies?
Does anyone in the home have dietary restrictions or specific eating habits the student should be aware of?
Do you expect the student to follow those restrictions while in your home?
Are you willing to host a student that has dietary restrictions?
Are you willing to provide 3 square meals a day?
* Students must have the option to pack a lunch from home. ** All lunches purchased at school, or during school hours, will be the student's responsibility to pay for. Breakfast is self served.
Are you willing to provide reasonable transportation to and from school and social activities?
Please explain your family's availability if the student chooses to participate in before or after school activities.
Is there public transportation to the school or is the school close enough to your home that the student could walk to and from activities? Please explain
Please describe your expectations regarding the responsibilities and behavior of the student while in your home (e.g. home work habits, household chores, curfew [school night and weekend] access to refrigerator/food, cooking, computer/internet/email/Skype,how much time is allowed, and what hours of the day.)
Describe a typical weekday in your home
Describe how you would hope to see your student interact with your family (daily activities, evenings at home, family outings)
Do any members of the family smoke indoors?
Does any member of your household work for a high school in a coaching, teaching, or administrative capacity?(If yes, please explain)
Has any member of your household been in contact with a coach in an attempt to arrange a student with a particular athletic ability?
If yes please list the contact and the sport.
Whose idea was it to host an international student?
Do all family members agree to this?
Does anyone residing in the home own a gun?
If yes, where are they located
Do you host for other organizations?
Do you expect the student(s) to spend major holidays with your family? Would it be acceptable to plan visits with other family/friends in the US during the holiday breaks from school?

Financial Information

The income data collected will be used solely for the purposes of ensuring that the basic needs of the students can be met, including three quality meals and transportation to and from school activities.
Average combined income range
Is anyone residing in the home receiving any kind of financial needs-based government assistance for food, housing or medical care? If so please describe who and the purpose for the assistance.

Refrences

Host family personal references - Needs to be non-relatives that have visited your home in the past 12 months. Please provide 3.
Reference 1

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How do you know this person?
How long have you known them?
Reference 2

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How do you know this person?
How long have you known them?
Reference 3

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
How long have you known them?
How do you know this person?

Family Alblum

PLEASE PROVIDE SEVERAL PHOTOGRAPHS WITH LABELS NAMING FAMILY MEMBERS (AND PETS) THAT WILL HELP FAMILIARIZE YOUR STUDENT WITH YOUR FAMILY. INCLUDE PHOTOS OF YOUR FAMILY, PETS, HOME, SPECIAL EVENTS, NEIGHBORHOOD, ETC.YOUR COORDINATOR WILL TAKE SEVERAL PHOTOS WHEN THEY ARE AT YOUR HOME FOR THE INTERVIEW. We are required to have a photo of 1) FAMILY- INCLUDING ALL MEMBERS LIVING IN THE HOME 2) STUDENT'S ROOM 3) FAMILY OR LIVING ROOM 4) EXTERIOR OF THE HOME AND GROUNDS 5) KITCHEN 6) STUDENT BATHROOM. Please add some photos that will help the student learn more about your family!
File Upload

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Criminal Background Check
CRIMINAL BACKGROUND AUTHORIZATION*** Every person in your home that has turned 18 years of age or will do so during the following school year MUST complete a background check for your family to be eligible to host a student. Please also be aware that if anyone moves into your home during the school year, you must notify your coordinator so the background check as well as any updated information can be added to this application. This is a strict guideline when minor children are involved and must be adhered to without exception.Thank you for your cooperation!The information on this page will be viewed only by Bridges International Group LLC. The coordinator, student and foreign agency will not have access to this data.

By signing below you agree that all occupants over the age of 18 will subject to a background check.
Parent 1

Clear
Parent 2

Clear

Host Family Agreement

It is important to read this entire page. The Host Family needs to check all the boxes below before electronically signing at the bottom of the page. By electronically signing below, the Host Family acknowledges that it understands and agrees to the following responsibilities and conditions:
The Host Family agrees that the student will reside with the Host Family for the duration of the student's stay on an educational program operated by Bridges International Group LLC. The Host Family will assume responsibility for the welfare of the student while the student resides in the home of the Host Family, in accordance with the Host Family Handbook.

The Host Family is not an employee of Bridges International Group LLC. Bridges International Group LLC will not provide fringe benefits, including health insurance, or any other benefits, for the Host Family. The Host Family is responsible for maintaining its own homeowner's insurance.

The Host Family will be paid only for the time in which the student is actually residing in the Host Family's home. Should the student be relocated at any time for any reason, the Host Family will be paid a pro-rated fee rounded to the full day as
determined by Bridges International Group LLC.

The Host Family agrees to notify Bridges International Group LLC immediately should the student violate any local, state, or federal laws or if the student should violate any of the Bridges International Group LLC Program Rules. These rules may be found in the Host Family Handbook.

The Host Family understands that should the student fail to abide by the Program Rules or any applicable law, Bridges International Group LLC may make the decision to terminate the student from the program.

If a student move is requested by the Host Family, the Host Family agrees to give Bridges International Group LLC at least a 2-week timeframe to secure a new host family for the student. If there is reason to believe that the student's well-being is at risk, Bridges International Group LLC may make the decision to remove the student from the Host Family's home with no advance notice provided to the Host Family or student.

The Host Family understands that the student may be removed from the Host Family as a result of events not involving the Host Family and that Bridges International Group LLC may only be able to provide limited information due to privacy laws and policies.

The Host Family understands that any independent domestic or international student travel requires prior approval in writing from Bridges International Group LLC.

The Host Family is aware of the Bridges International Group LLC 24-hour emergency phone number that can be found in the Host Family Handbook.

The Host Family agrees and understands that students may not ask to borrow money and the Host Family will not share any bank or other financial accounts with the student.

The Host Family agrees to inform Bridges International Group LLC of any material changes regarding the status of the family and/or students, including, but not limited to, changes in address, finances, employment, and criminal arrests.

The Host Family agrees to host no more than two international students at any one time. If the Host Family hosts two students at once, each student must be of a different nationality. Exceptions to this rule are only permitted with a written
request from the natural parents and with written approval from Bridges International Group LLC.

Our family has reviewed all of the rules and guidelines set forth for host families and students provided by Bridges International Group LLC, and all of our questions have been answered in a satisfactory way, resulting in our ability to confirm that we are comfortable with the responsibility (financially, ethically, physically and emotionally) of hosting and supporting an international student.

We agree to communicate on a regular basis with our International Coordinator (IC) to foster the ideal environment for all parties to have a successful experience.
Signature Parent 1

Clear
Signature Parent 2

Clear
Should be Empty:

Host Family Application

PROFILE

Host Parent Information

Other Occupants

Host Family Questionnaire

Financial Information

Refrences

Family Alblum

Criminal Background Check

Host Family Agreement