KAP Host Family Application
Personal/Family Information
Adult/Parent Name
*
First Name
Middle Name
Last Name
Birth Date
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
Email
*
example@example.com
Occupation
*
Employer
*
Adult/Parent Name
First Name
Middle Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
Email
example@example.com
Occupation
Employer
Children at Home (Gender, Age, Interests/Hobbies, Grade)
Other people living in your home
Family Pet(s)
Family Interests/Hobbies?
*
Have you hosted before?
*
Yes, with a different program
Yes, with KAP
No
Has anyone in your family been an exchange student? If so, who, when, and where?
Confirm Statements
Our family is expected to treat the exchange student or adult guest as one of the family and will make a conscious effort to include the visitor in all family activities
*
Yes
No
We are expected to read any information provided by KAP and familiarize the family with any materials in preparation for the exchange
*
Yes
No
Our family must be flexible, patient, and willing to communicate both verbally and non-verbally while hosting a person from another country
*
Yes
No
Family members should make sure that the visitor feels comfortable around friends and feels included in activities
*
Yes
No
We will contact the KAP coordinator immediately if illness or other problems occur
*
Yes
No
We will contact the KAP coordinator regarding plans to take our visitor out of WI for the day or anywhere other than our home overnight
*
Yes
No
As due diligence and safety for all participants, a background check may be performed on our family
*
Yes
No
Signatures
Adult/Parent Signature
*
Clear
Adult/Parent Signature
Clear
Submit
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