United Studies, Inc. Host Family Application

UNITED STUDIES STAFF ONLY: Date application was uploaded to 365

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Thank you for your interest in hosting a United Studies exchange student! Please complete the application below. Please note that if you only partially complete a page of the application, the information on that page will not be saved. You must complete the entire page and click "Next" in order for that information to be saved.

If you experience any problems completing the host family application, please contact your local coordinator or email our applications manager.

Host Family Approval Process
- online application
- background checks for all host family members over 17 years of age who live in the home either full-time or part-time.
- in-home interview by a United Studies Local Coordinator
- three reference checks supplied by host family and contacted by Local Coordinator
- host family pictures submitted by Local Coordinator: host family, front of house, back of house, living room, kitchen, students bedroom and students bathroom
- choose the student that will become a new family member (this can be done with input from United Studies staff)
Host Family Application
What Type of Program are you Applying For?
Family Information
Basic Information
Host Family Last Name(s):*
Street Address:*
City:*
State:*
Zip:*
Phone:*
E-mail
If Address above is a P.O. Box, please give actual street address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

The Community
Do you know of community service opportunities within your area in which exchange students might participate? If so, please share.
In what type of community do you live? Please select any that apply.*

UrbanSuburbanSmall TownSemi-RuralRural
Community Population:*
Closest Major City:*
Distance to above-named major city:*
Population of above-named major city:*
Briefly describe your neighborhood and community:*
What points of interest are near your area (parks, museums, historical sites)*
Areas in or near neighborhood to be avoided:*
Please indicate the commercial airport(s) where you could meet your student at the beginning of the program and take your student at the end of the program. Please note that, while the ticketing agency will try to obtain your first choice of airports, they must consider many factors such as airline contracts, group travel, ticket cost, flight availability, and arrival and departure times.
1st Choice:*
Airport Code:*
City:*
Miles from home*
2nd Choice:
Airport Code:
City:
Miles from home
Students are typically asked to arrive 7-10 days before the start of school and to depart 7-10 days after the end of school. Host families are asked to pick up and drop off students at the local airport. Do you have any conflicts with this?*
What websites might help the student to learn more about your surroundings: (e.g. City, County, State, High School, Universities, Parents Work, Newspapers, Museums, Attractions, etc.)
Website:
Website:
Website:
Website:

Emergency Contact

Please provide contact information for a friend or relative not living in your home who is aware of your family's activities as well as a coworker of one parent.
Name:*
Relationship:*
Address:*
City:*
State:*
Zip:*
Phone:*
E-mail*

References

Please provide contact information for three individuals in your community not related to you or to United Studies representatives who could attest to your family's character, including, if possible:
- one official in the school that the exchange student would attend, and
- one coworker of each parent.
- Please do NOT list anyone related to you.
Name:*
Relationship:*
Address:*
City:*
State:*
Zip:*
Phone:*
E-mail*
Name:*
Relationship:*
Address:*
City:*
State:*
Zip:*
Phone:*
E-mail*
Name:*
Relationship:*
Address:*
City:*
State:*
Zip:*
Phone:*
E-mail*

Family Photo
If you have a family photo that includes all members of the household, please upload it here. United Studies must provide a photo of all household members to the exchange student. During your in-home interview, your United Studies Local Coordinator will take photos of your home and could also take a photo of your family at that time, if needed.

Select File

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Policy on Home Placement
Host Family Acknowledgement and Agreement
United Studies, Inc. believes it is in the best interest of its program participants to have the following program policies set forth in writing, therefore providing a better understanding of the international exchange experience for its participants.
1. Acknowledgement: I acknowledge that the information set forth above is true and correct.
2. Discrimination: I understand and accept that United Studies does not discriminate on the basis of race, color, national origin, religion, or sex in making selections and placements; nor does United Studies discriminate with regard to counseling issues and the guidance provided.
3. Acceptance: I acknowledge and understand that the completion of a Host Family Application does not confirm the placement of student in our home, nor does it commit us to accepting a student in our home.
4. Confirmation: I acknowledge and understand that, if selected as a host family, the placement of a student in my home will not be confirmed until he/she has been accepted in writing by the local school district or private high school.
5. Hosting Information: I acknowledge and understand that I will be provided with a copy of the student’s biography and United Studies Host Family Handbook upon confirmation of placement.
6. Participant Policy: I acknowledge that I will receive a copy of the following: Student Rules of Conduct, Host Family Agreement and U.S. Department of State “Criteria for Exchange Visitor Programs”.
7. Support and Compliance: I agree to support and comply with the Host Family Terms of Agreement and Student Rules of Conduct and will do my best to ensure that the student abides by the rules of conduct. Further, I agree to inform United Studies of any and all material changes in the status of our family or the exchange student, including, but not limited to, changes in address, finances, employment and criminal arrests.
8. Health and Welfare: I agree to assume responsibility jointly with United Studies for the health and welfare of the student while he/she is in our home. I will make a genuine effort to include my student in my family as a son or daughter.
9. Contact and Progress: I understand that a United Studies Local Coordinator will be in regular contact with my family, student and school. I agree to work with the United Studies representative by regularly reporting the student’s progress.
10. Cooperation: I agree to cooperate and work with the United Studies staff during the year. I understand that United Studies shall have final authority in all decisions concerning: student’s placement, rules and discipline, length and time student remains in any home or area, and student’s arrival and departure. United Studies has the right to remove the student from my home at any time, or to cancel the placement prior to student arrival.
11. Hosting Experience: If at any time I wish to discontinue hosting the student, I will notify my United Studies Local Coordinator immediately and allow and least 2 weeks for the student to be relocated.
12. Returning Students: I agree that if my student wants to return as a J-1 or F-1 exchange student in the future, we will work with United Studies to help the student obtain their Visa.
Signature of host parent 1:

Clear
Signature of host parent 2, if applicable:

Clear
Today's date:*

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Thank you for taking the time to complete this application. The information provided will be of great assistance as the student prepares for his or her stay in the United States. Additional forms may be required before your family can be approved.
Email
example@example.com
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