Demographics
Full Name Parent #1
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First Name
Last Name
Email Parent #1
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example@example.com
Cell Phone Parent #1
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Please enter a valid phone number.
Full Name Parent #2
First Name
Last Name
Email Parent #2
example@example.com
Cell Phone Parent #2
Please enter a valid phone number.
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation Parent #1
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Occupation Parent #2
Please list children and all others living in your home: full name, birthdate, gender, relationship, occupation, and whether this is their permanent residence. If there are none, please indicate as such.
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References
Reference #1 - Full Name/Relationship
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Reference #1 - Address
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Reference #1 - Number of Years Known/ Phone Number/Best Time to Contact
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Reference #2 - Full Name/Relationship
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Reference #2 - Address
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Reference #2 - Number of Years Known/ Phone Number/Best Time to Contact
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Reference #3 - Full Name/Relationship
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Reference #3 - Address
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Reference #3 - Number of Years Known/ Phone Number/Best Time to Contact
*
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Home Life
What languages are spoken at home?
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Does anyone smoke inside of the home?
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Yes
No
How would your family feel about accepting a student who holds customs and practices traditions that are different from your own?
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Does your family practice religion?
Yes
No
If yes, what religion?
Would you expect the student to attend religious services regularly?
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Pets
Does your family own pets?
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Yes
No
If yes, list them and state whether they live inside or outside the home.
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Dietary
Please describe any special dietary habits that your family follows (gluten-free, vegan, etc.). Would you require your host student to follow this diet as well?
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How would your family feel about hosting a student with dietary habits different from yours (vegan, gluten-free, etc.)?
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Hosting Experience
Has your family hosted an International Student before?
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Yes
No
List the country and date for each student you have previously hosted.
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General Home Questions
Will the student have his or her own room?
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Yes
No
Can you provide a quiet study area?
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Yes
No
Do you feel your family is financially able to support an international student living in your home?
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Yes
No
Please tell us about your family. How would you describe the personality of your family? Do you have any special interests you pursue such as sports, travel, the arts, etc?
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Are there any health concerns in the family (whether related to physical or mental health) that could potentially impact the home situation of a host student?
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Please describe your daily routine as a family. Is there a time of year that is particularly busy for your family?
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If the student wanted to participate in after school activities would you be able to accommodate their transportation?
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Yes
No
What family household chores would you expect your student to perform regularly?
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Do you need to have Lake Ridge Academy transportation (Note: the bus does not wait for after school activities)?
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Morning
Afternoon
Both
None
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Background Information
Have you or any member of your household ever been convicted of a felony?
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Yes
No
If yes, please explain the circumstance:
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Do you know of other families who might be interested in hosting an International Student?
Would you be willing to host a student short term when the current host family cannot (vacations, work trips, etc.)? If so, do you have limitations as to what type of student (gender, etc.)?
I/we understand that as host parents I/we are not the legal guardian(s) of the International Student living in my/our home and that the student’s natural parents solely retain this authority. I/we certify that my/our answers are true and complete to the best of my/our knowledge.
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Type Full Names Here
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