Faith Christian Academy Host Family Application

Host Family Application

International Student Program
Thank you for your interest in hosting an international student with Faith Christian Academy. FCA is certified through the US Government Homeland Security Department and SEVIS (Student Exchange Visitor Information Service) program to provide I-20 for Full-time Students for F1 student Visa.

FCA places students in family homes that support the mission and ministry of the school. Families must complete a background check for all adults living in the home. The primary language spoken in the home is English. All families are carefully screened and undergo a home visit and a reference check. Families must also attend a training session to review school host family policies before becoming a host family. An allowance is provided to each family to ensure a caring environment where parents can feel secure that their child is being well cared for. If you have any questions, please contact the International Department at Intldept@fcalions.org.
1. Primary Host Name*
Head of House
2. Date of Birth*

MonthDayYear
Date of Birth
3. Occupation*
4. Cell Phone Number*
5. Business Phone Number
6. Email Address*
example@example.com
7. Secondary Host Name*
*Usually the mother
8. Date of Birth*

MonthDayYear
Date of Birth
9. Occupation*
10. Cell Phone Number*
11. Email Address*
example@example.com
12. Street Address*
13. City*
14. State*
15. ZIP Code*
16. Years Lived at Current Address*
17. Square Foot Size of the House*
18. Type of Home*

Single FamilyApartmentDuplexOther
19. Number of Bedrooms*
20. Will the Student Being Hosted Share a Room?*

YesNo
21. Number of Bathrooms*
22. Will the Student Being Hosted Share a Bathroom?*

YesNo
23. Number of Common/Social Areas*
Example: Living Room, Family Room, etc.
24. List All People Who Will Be Living in The Household (Including Children):*
*List their Name, Profession, Age, and Relation to Host
25. Do You Have Any Pets?*

YesNo
26. What Kind of Pets? Please, Describe.
27. How Far is Your House From FCA?*
28. Can You Provide Transportation To and From School? How?*
29. Please, Describe Your Family Car(s) Used For Student Transportation*
Include Make and Model
30. Is Anyone In The Household Receiving Government Benefits?*

YesNo
31. If Yes, Please Explain.
32. Is Anyone Of The Family Members with a Chronic Illness, Disability, or Disorder?*

YesNo
33. If Yes, Please Explain.
34. How Did You Hear About Our Program?*

School EmailWebsiteWord of MouthFriendOther
35. Why Do You Want to Host an International Student in Your Home?*
36. What are Your Families Hobbies and Interests?*
37. Activities You Might Do with The Student?
38. Is English Your Primary Language?*

YesNo
39. If No, What is Your Primary Language?
40. Are You a Member of Faith Assembly?*

YesNo
41. Describe Your Family's Church Involvement*
Example: Active, Occasional, Often, Seldom/Never
42. If You Have Children, Are They Active in The Church Youth Program?*

YesNo
43. Are Alcoholic Beverages Kept in Your Home?*

YesNo
44. Does Anyone in The Household Smoke?*

YesNo
45. Do You Have A Gender Preference?*

Male StudentFemale StudentNo Preference
46. Preferred Grade*

8th9th10th11th12thNo Preference
47. How Long are You Willing to Host a Student?*
48. How Many Students Can You Host at One Time?*
49. Have You Previously Hosted an International Student?*

YesNo
50. How Many Years and How Many Students Have You Hosted?
51. What Country or Countries were the students from?
52. List Two References (other than family)*
*Please Provide Their Name, Relationship, Contact Number, and Email
53. Criminal Records Check Agreement: Are You and All Individuals 18 Years of Age & Older Living in The Household Willing to Undergo a Confidential Criminal Records Check?*

YesNo
I hereby affirm that the information in this Host Family Application is accurate and true to the best of my knowledge. This information is strictly for homestay purposes and will remain confidential. I agree not to hold Faith Christian Academy responsible for any damages, losses, or injuries that may occur during the homestay period.
54. Primary Host Signature: By Signing My Name Below, I Understand and Agree that This Form of Electronic Signature Has the Same Legal Force and Effect as a Manual Signature. *

Clear
55. Date Signed*

MonthDayYear
Date
56. Secondary Host Signature: By Signing My Name Below, I Understand and Agree that This Form of Electronic Signature Has the Same Legal Force and Effect as a Manual Signature. *

Clear
57. Date Signed*

MonthDayYear
Date
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