Host Family Application

The purpose of the Host Family in the program is (1) to assist the student in the process of adapting to U.S. culture while the student is achieving program and personal objectives and (2) to provide the student with adequate room and board.

Fields marked * are required.

General Information

(If less than 1 year, please list previous address below.)

Please list names of all persons in the immediate family
(including host parents)
Name* Age* Gender* Living at Home* Relationship*
Yes   No  
Applicant's Occupation Information
AM   PM  
Home   Work  
Spouse's Occupation Information
AM   PM  
Home   Work  
How did you hear about the host family program?*

Host Family Information
Why does your family want to host an international student?
Please write a few sentences here to explain how your student will benefit from living in your home
What are your perceptions of international students and their needs?
Has your family ever hosted an international student before?*
Yes No

Yes No

Yes No

Yes   No  

Yes No Maybe

Yes No

Yes   No  

Yes   No  

Yes No Uncertain

School Information
Host Family Background
Yes No

Yes No
Further Information
Please indicate your hosting preferences (if any)

Male   Female

Academic year  
Temporary housing upon arrival only
Host Family References

 Reference 1
 Reference 2
Program Agreement

 I/We hereby certify that the information given on the pages of the Host Family Application is true and complete to the best of my/our knowledge.*