Host Family Application

Thank you for applying to host an intern! The primary requirements for an Intern Host Family are:

You live within a 45 minute bus ride of one of the three schools (Richmond, Mt. Tabor, or Grant: visit the Trimet website to confirm )
You have a separate bedroom for the intern. Bathrooms may be shared.
Your family will be able to host for 6 months (Fall/Winter or Spring/Summer)
All members of your household accept and welcome into your home and treat your intern as a member of the family.
Provide a comfortable, safe, and supportive environment for your intern.

Please submit the questionnaire below and complete the PPS Volunteer Background Check for all adults in your household, and the Intern Coordinator will contact you regarding next steps. Please contact coordinator@oyanokai.org if you have any questions.

Family Last Name(s)*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Primary Phone Number*

Please enter a valid phone number.

Primary Email*

example@example.com

Please list information for all adults in your household below. Each individual over 18 must complete a separate PPS Volunteer Application and Background Check.

Adults in Household*

	First Name	Last Name	Occupation	Email	Cell Phone	Family Relationship	PPS Application Submitted?
Adult #1
Adult #2
Adult #3
Adult #4

Children in Household*

	Name	Gender	Age	Grade	School
Child #1
Child #2
Child #3
Child #4

Which term would you like to host?*

Fall/WinterSpring/SummerEitherBoth

Do you have a gender preference in hosting an intern?*

No PreferenceFemaleMaleOther

Do you have previous experience hosting an intern or foreign students?*

NoYes (please explain)

Do you have any smokers in your family?*

NoYes

Do you keep firearms in your home?*

NoYes

Other than English, does your family speak any other languages?*

NoYes (please explain)

Would you be opposed to informing an intern that you host in advance of any religious affiliations of household members?*

NoYes

Would any member of the household have difficulty hosting an intern whose religious beliefs were different from their own?*

NoYes

If your family has any pets, please list below:

If your family has a special diet (Vegetarian, Vegan, etc) or allergies to particular foods, please describe below:

Are there any other circumstances that may affect hosting an intern? Please describe below:

Please upload a digital photo of your family:*

Signature of Adult #1*

Clear

Signature of Adult #2

Clear