STUDENT(S)
HOST FAMILY APPLICATION
LAST Name
Male Head of Household
Female Head of Household
Address
Address
Street Address Line 2
City
State
Zip
Mailing Address
Occupation
Occupation
Work Phone
Format: (000) 000-0000.
Work Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Cell Phone
Format: (000) 000-0000.
Email
example@example.com
Email
example@example.com
Skype
Facebook
Children Living In Home
Name
Sex
Age
Interests
Name
Sex
Age
Interests
Name
Sex
Age
Interests
Name
Sex
Age
Interests
Other persons living with family
Special diet
Does anyone smoke?
Yes
No
Do you allow smoking inside?
Yes
No
Do you allow smoking outside?
Yes
No
List any indoor pets
Outdoor pets
Do you consider your home active average or quiet
Do you attend church regularly?
Yes
No
What denomination
List any special family interests:
Language other than English spoken in home
How many students would you be interested in hosting this season
Do you prefer male or female
Have you hosted before
What Nationalities
Will the students share a room?
Yes
No
With whom
Local References
Name
Address
Phone
Format: (000) 000-0000.
Name
Address
Phone
Format: (000) 000-0000.
Name
Address
Phone
Format: (000) 000-0000.
Stop Location
List any questions or concerns I can answer for you:
Air Mattress
Yes
No
Air Mattress
Yes
No
Notes
Preview PDF
Submit
Should be Empty: