Host Family Application
OCEAN-Organization for Cultural Exchange Among Nations
Host Family's Name:
*
Please select the program for which you are applying.
*
Academic Year (August - June)
Semester (August - December)
Semester (January - June)
Summer Program
If you are interested in hosting a summer student, please list the dates that you are available to host.
*
Street Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Is your street address the same as your mailing address?
*
Yes
No
If not, please enter your mailing address below.
*
Mailing Address
Mailing Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Home phone or primary phone number for your family.
*
Type of Phone:
*
Cell Phone
Landline
Host Parent #1's Name:
*
First Name
Last Name
Date of Birth:
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender:
*
Male
Female
Do you have a cell phone?
*
Yes
No
Cell Phone:
*
May we contact you by text?
*
Yes
No
E-mail:
*
example@example.com
Do you live in the home full or part-time? (i.e., Do you have to spend an extended period of time away from home due to your job or other circumstances?)
*
Full-Time
Part-Time
Please explain:
*
Level of Education Achieved:
*
High School
Vocational
Military
B.A./B.S.
M.A./M.S.
Ph.D.
Other
Please select one of the following:
*
Employed
Self-Employed
Unemployed
Retired
Stay-at-Home Parent
Other
Employer's Name:
*
Job Title:
Employer's Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Work Phone:
*
Please note than we will only call you at work if there is an emergency.
Number of Years with Current Employer:
*
Less than 1 year
1 - 3 years
4 - 6 years
7 - 10 years
More than 10 years
Working Hours:
*
If other, please explain:
Is there a 2nd host parent in the home?
*
Yes
No
Host Parent #2's Name:
*
First Name
Last Name
Date of Birth:
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Gender:
*
Male
Female
Do you have a cell phone?
*
Yes
No
Cell Phone:
*
May we contact you by text?
*
Yes
No
E-mail:
*
example@example.com
Do you live in the home full or part-time? (i.e., Do you have to spend an extended period of time away from home due to your job or other circumstances?)
*
Full-Time
Part-Time
Please explain:
*
Level of Education Achieved:
*
High School
Vocational
Military
B.A./B.S.
M.A./M.S.
Ph.D.
Other
Please select one of the following:
*
Employed
Self-Employed
Unemployed
Retired
Stay-at-Home Parent
Other
Employer's Name:
*
Job Title:
Employer's Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Work Phone:
*
Please note that we will only call you at work if there is an emergency.
Number of Years with Current Employer:
*
Less than 1 year
1 - 3 years
4 - 6 years
7 - 10 years
More than 10 years
Working Hours:
*
If other, please explain:
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Person to Contact in Case of an Emergency (Must be someone that does NOT live in your home):
*
First Name
Last Name
What is his/her relationship to you?
*
Address:
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
E-mail:
*
example@example.com
Phone Number:
*
Do you have children or step-children?
*
Yes
No
Please list their names below.
*
Name
Gender
Date of Birth
Age
Do they live in your home full or part-time?
Are there any other persons living in the home (i.e., friends, other relatives, another exchange student, etc.)
*
Yes
No
Please list their names below.
*
Name
Gender
Date of Birth
Age
Relationship to Family
Do they live in your home full or part-time?
Approximately how long have you lived at the present address?
*
Less than 1 year
1 - 3 years
4 - 6 years
7 - 10 years
More than 10 years
Type of Home:
*
Apartment
Condominium
Duplex
Mobile Home
Single Family Home
Townhouse
# of Bedrooms:
*
1
2
3
4
5
More than 5
# of Bathrooms:
*
1
1-1/2
2
2-1/2
3
More than 3
Is this residence the site of a functioning business (i.e., daycare, farm, etc.)?
*
Yes
No
If yes, Please explain:
Please list any amenities that would be available to the student (i.e., swimming pool, exercise equipment, computer, etc.):
Utilities (Check all that apply):
*
Electric
Natural Gas
Propane
Septic Tank
Sewer
Well Water
City Water
Do you reside on a military base or Indian Reservation?
*
Yes
No
If yes, please explain:
*
Please give a brief description of your neighborhood and community.
*
Is there public transportation available in your area?
*
Yes
No
If so, what kind?
*
What is the approximate population of your community?
*
Less than 1,000
1,000 - 10,000
10,000 - 25,000
25,000 - 50,000
50,000 - 100,000
100,000 - 250,000
250,000 - 500,000
500,000 - 750,000
750,000 - 950,000
More than 950,000
How would you describe your community?
*
Urban
Suburban
Small Town
Rural
What is your city, town or community's website?
What points of interest are near your home (i.e., parks, museums, historical sites, etc.)?
Are there any areas in or near your neighborhood that you feel the student should avoid?
*
Yes
No
If so, please explain.
*
If you live in a small town or rural area, what is the nearest major city?
How far is it from your home?
What is the city's approximate population?
What is the nearest airport?
*
How far is it from your home?
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Which school would the student attend?
School Phone Number:
School Fax Number:
School Address:
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What is the high school's approximate population?
100 students or less
100 - 500 students
500 - 1000 students
More than 1,000 students
How far is the high school from your home?
How will the student get to and from school?
*
School bus
Walking or bicycling
Ride with host parent
Ride with host sibling
Other
Approximate school start date:
Approximate school end date:
Please provide a description of the high school (activities offered to students, campus description, student body, etc.):
Please list some activities that are available to teenagers in your community:
*
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Please check any activities below that your family members participate in on a regular basis.
*
Aerobics
Cycling
Rollerblading
Archery
Dancing
Sailing
Arts & Crafts
Fishing
School Clubs
Astronomy
Football
Sewing
Auto Mechanics
Gardening
Skateboarding
Auto Racing
Golf
Skiing
Baseball
Gymnastics
Soccer
Basketball
Hiking
Surfing
Billiards/Pool
Hockey
Swimming
Boating
Horseback Riding
Table Tennis
Bowling
Hunting
Tennis
Camping
Ice Skating
Theater/Drama
Card Games
Martial Arts
Track/Running
Chess
Museums
Video Games
Classical Music
Photography
Volleyball
Computers
Racquetball
Water Skiing
Cooking
Reading
Windsurfing
Please list any additional activities that your family may participate in that are not included on the list above.
Does any member of your family participate in volunteer activities within the community?
*
Yes
No
If so, please explain.
*
Please give a brief description of each family member's personality.
*
Does any member of your family play a musical instrument?
*
Yes
No
If so, please describe.
*
Do you have any musical instruments available in your home?
*
Yes
No
Please check all that apply:
*
Accordion
Harmonica
Trombone
Cello
Harp
Trumpet
Clarinet
Keyboard
Tuba
Drums
Oboe
Ukulele
Flute
Organ
Viola
French Horn
Piano
Violin
Guitar
Saxophone
Xylophone
Other
What type of music does your family listen to?
Alternative
Dance/Electronic
Latin
Blues
Folk
Pop
Christian
Hard Rock/Metal
R&B
Classical
International
Rap/Hip-Hop
Country
Jazz
Rock
Other
Do you have any pets in your household?
*
Yes
No
If so, please list how many and provide a brief description (i.e., cat, dog, fish, etc.).
*
Are pets kept primarily inside or outside of the home or both?
*
Do any members of your family smoke?
*
Yes
No
If so, who?
*
Do they smoke inside or outside of the home or both?
*
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Are you willing to inform the exchange student in advance of the religious affiliation of any members of your household?
*
Yes
No
If yes, what is your family's religious affiliation?
*
Please describe your family's religious beliefs?
*
Not Strong
Average
Strong
Not Applicable
Would you like for your international student to attend religious services/activities with you on a regular basis?
*
Yes
No
Only if he/she wants to
If yes, how often?
*
Would any members of your household have difficulty hosting a student whose religious beliefs are different from their own?
*
Yes
No
If yes, please explain.
*
Have you every hosted an international student before?
*
Yes
No
If so, when and for how long?
*
What was the student's nationality?
*
Through what organization did he/she come to the U.S.?
*
What is the primary language spoken in your home?
*
Is any member of your family fluent in another language?
*
Yes
No
If yes, please elaborate.
*
What is your family's combined annual income? (The income date collected will be used solely for the purposes of ensuring that the basic needs of the exchange student can be met, including three quality meals and transportation to and from school activities."
*
Less than $25,000
$25,000 - $35,000
$35,000 - $45,000
$45,000 - $55,000
$55,000 - $65,000
$65,000 - $75,000
$75,000 and above
Does anyone in the home receive any kind of public assistance (financial needs-based government subsidies for food or housing?
*
Yes
No
If so, please explain.
*
Has your family ever had any contact with Child Protective Services in the past?
*
Yes
No
If so, please explain.
*
How did you learn about our cultural exchange program?
*
Area Representative
Church Bulletin
E-mail Request
Facebook
Friend
Former Host Family
Newspaper Ad/Article
Poster/Brochure
School Flier
Other
If other please elaborate.
If you were referred to us would you please share the name of referral source so we can thank them?
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Describe any concerns you may have about hosting an international student?
*
How do your children feel about welcoming an international exchange student into their home? (If applicable)
Please describe a typical weekday in your household and give a brief description of your family's lifestyle.
*
Why do you want to host an exchange student? What do you think your family will gain from a cultural exchange, and how will it benefit the exchange student?
*
Please list some activities that would help you share your culture with an international student.
*
Please describe your expectations regarding the responsibilities and behavior of the student while he/she is in your home. (i.e., completion of homework, household chores, curfew on school nights and weekends, household rules, computer/internet usage, etc.)
*
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Does anyone in your family have any physical or psychological disability/illness?
*
Yes
No
If yes, please describe.
*
Does anyone in your family have any special dietary practices or restrictions?
*
Yes
No
If yes, please describe.
*
Would you expect your student to follow any specific dietary restrictions?
*
Yes
No
If yes, please explain.
*
Would you feel comfortable hosting a student who follows a particular dietary restriction (i.e., vegetarian, vegan, no red meat, etc.)?
*
Yes
No
Please describe your family's dietary habits.
*
We prepare and eat the majority of our meals at home.
We eat in restaurants on a regular basis (almost every day).
We eat out once a week.
We eat out twice a week.
We eat out once a month.
We rarely eat in restaurants.
Other
Is your family willing to provide special transportation so that the student may participate in extracurricular activities either after school, in the evenings or on weekends?
*
Yes
No
Comments:
Do any of your children attend the same school in which the international student will be enrolled?
*
Yes
No
There are no children living in the home.
If so, please list any sports, clubs, activities, etc. that your children participate in at the school.
*
Does any member of your household work or volunteer for the high school in a coaching, teaching or administrative capacity?
*
Yes
No
If so, please explain.
*
Has any member of your household had contact with a coach regarding the hosting of an exchange student with a particular athletic ability?
*
Yes
No
If so, please describe the contact and name the sport.
*
Give a brief description of the climate in your area. What is the appropriate clothing for the student to bring?
*
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What is your hosting preference?
Male
Female
Doesn't Matter
What is your age preference?
14
15
16
17
18
Doesn't Matter
What personality traits do you prefer (i.e., quiet, outgoing, active)?
Please list any other preferences you might have in regards to the student.
It is mandatory that the student have his/her own bed; however, he/she may share a bedroom with a host sibling of the same gender who is 12 years or older. The student may share a bedroom with no more than one other person. The student must also have a place where he/she can store his/her clothing and personal belongings. Will the student have his/her own bedroom?
*
Yes
No
If not, with whom will he/she share a bedroom?
*
Will the student's room have a place for him/her to study?
*
Yes
No
If not, where will he/she study?
*
Please click on the submit button below to complete this portion of the application.
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