Faith Christian Academy Host Family Application

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

Date of Birth

3. Occupation

4. Cell Phone Number

Format: (000) 000-0000.

5. Business Phone Number

6. Email Address

example@example.com

7. Secondary Host Name

*Usually the mother

8. Date of Birth

Date of Birth

9. Occupation

10. Cell Phone Number

Format: (000) 000-0000.

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

Other

19. Number of Bedrooms

20. Will the Student Being Hosted Share a Room?

21. Number of Bathrooms

22. Will the Student Being Hosted Share a Bathroom?

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?

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?

31. If Yes, Please Explain.

32. Is Anyone Of The Family Members with a Chronic Illness, Disability, or Disorder?

33. If Yes, Please Explain.

34. How Did You Hear About Our Program?

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?

39. If No, What is Your Primary Language?

40. Are You a Member of Faith Assembly?

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?

43. Are Alcoholic Beverages Kept in Your Home?

44. Does Anyone in The Household Smoke?

45. Do You Have A Gender Preference?

46. Preferred Grade

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?

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?

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.

55. Date Signed

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.

57. Date Signed

Date