Host Family Information Form

Please fill out the form by clicking the button below.

Family Name *

Street Address *

City

State/Province

ZIP / Postal Code

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

Preferred Family Contact Cell Phone Number

Pref. Family Contact Email Address

First NamePrimary Host Parent (i.e. host mom)

Last NamePrimary Host Parent (i.e. host mom)

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

Primary Host Parent's Cell Phone Number

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

Last NameSecondary Host Parent (i.e. host dad) (if single, ignore this section)

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

Secondary Host Parent's Cell Phone Number

Secondary Host Parent's Email Address

Family members living in the housePlease 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? *

If Yes, please describe type and number of pets

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

Religion (optional)

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

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

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 arrange for the student to get the necessary transportation through friends/other host families?

Has your family hosted an exchange student before? *

Family Preferences: please indicate your exchange student gender preferences.

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

There are a few "pairs" of students (brothers or sisters) who would like to stay together. Are you open to taking two or possibly more students? *

Would the exchange student have his/her room? *

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

Please describe any preferences or requests from your family

Short paragraphPlease 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 fileFinally, 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.