Host Family Application

ACE International Host Family Application~
Hosting Location*
Guardian 1
Name*

First NameMiddle NameLast Name
Guardian 1 Birthdate *
Occupation
Home Phone

Area CodePhone Number
Cell Phone*

Area CodePhone Number
E-mail*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Will there be a Spouse/Partner/Adult Child (2nd Guardian or Adult) in the home?

YesNo
2nd Adult in Home
Name

First NameMiddle NameLast Name
Guardian/2nd Adult Birthdate
Gender
Relationship
Occupation
Home Phone

Area CodePhone Number
Cell Phone

Area CodePhone Number
E-mail

Your Home
Is your home active, average, or quiet?
List any other adults living in your home:
Special Diet?
Does anyone in your household smoke?
List any outdoor pets
List any indoor pets
Does your family have a religious affiliation?
What denomination?
Does your family attend church regularly?
List any family interests
List the languages other than English spoken in your home consistently, not just ones you know!

About Hosting
Please tell us why you want to host.
How many students are you interested in hosting this summer?
Are you interested in hosting a male or female student?*
What ages are you interested in hosting (check all that apply)

13141516171819Chaperone (Adult)
Have you hosted before?*
What nationalities?
Will your student share a room?

Local References

Because you will be hosting a minor in your home, we will be doing a background check of all adults living in the home.
Reference 1 (not a relative, has been to your home)*

First NameLast Name
City, State*
Phone Number*

Area CodePhone Number
How long have you known them?
How are you acquainted?
Reference 2 (not a relative, has been to your home)*

First NameLast Name
How long have you known them?
How are you acquainted?
City, State*
Phone Number*

Area CodePhone Number
Reference 3 (not a relative, has been to your home)*

First NameLast Name
How long have you known them?
How are you acquainted?
City, State*
Phone Number*

Area CodePhone Number
How did you hear about us?*
Please list any questions or concerns
Once you submit your application, we will contact you shortly.

Thank you!
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ACE International Host Family Application~