Family Name

Address

City

State

Postal Code

Preferred Family Contact Name (this parent will receive all future communications)

Pref. Family Contact Cell Phone Number

Pref. Family Contact Email Address

First Name Primary Host Parent (i.e. host mom)

Last Name Primary Host Parent (i.e. host mom)

Primary Host Parent's Occupation/Background and/or Organization

Primary Host Parent's Cell Phone Number

First Name Secondary Host Parent (i.e. host dad) (if single, ignore this section)

Last Name Secondary Host Parent

Secondary Host Parent's Occupation/Background and/or Organization

Secondary Host Parent's Cell Phone Number

Secondary Host Parent's Email Address

Please list family members living in the house (outside of host mom/host dad). For example, how many children, their names/ages and grade levels.

Pets in House? Pets in House? *NoYes

If Yes, please describe type and number of pets

Would your exchange student be expected to attend church with you? Would your exchange student be expected to attend church with you? YesNo

Religion (optional)

Special dietary restrictions Does your family have any special dietary restrictions that the exchange student should know about?

Do you feel comfortable with that? Do you feel comfortable hosting a student who follows a particular dietary restriction (example: dairy free, gluten free, etc.)?

Would you be willing to provide transportation to school or activities if needed? Are you willing to provide transportation to the high school or to extracurricular activities after school or in the evening, if required?

If not, could you help arrange transportation through friends or other host families? If not, could you arrange for the student to get the necessary transportation through friends/other host families?

Has your family hosted an exchange student before? Has your family hosted an exchange student before? *YesNo

Gender Preference Family Preferences: please indicate your exchange student gender preferences. Gender Preference MaleFemaleCan be either

Will you accept someone of a different gender? If your choice of gender is not available, will you accept someone of a different gender? Will you accept someone of a different gender? *YesNo

One or two exchange students? Would you prefer to host one or two exchange students? One or two exchange students? *OneTwo

Would the exchange student have his/her room? Would the exchange student have his/her room? Would the exchange student have his/her room? *YesNo

Please explain accommodation plans If no, please explain accommodation plans for the visiting student.

Please describe any preferences or requests from your family

Please write a short paragraph to your future exchange student. You might want to share details about your family, school, activities you are involved in, and your community. Additionally, expressing your hopes and enthusiasm for this experience, as well as any other information you believe would interest the student, would be beneficial as they learn more about you and your family.

Upload picture of your family here Finally, please submit a photo of your family that we can share with the exchange student and his/her family. This photo will not be shared with anyone else.File InputChoose FilesNo Files ChosenAccepted file types: jpg, jpeg, jpe, png, webp, heic, pdf. Max. file size: 5 MB