Please enter adults responsible for hosting students and their relationship
*Last Name: First Name Relationship
*Present Address: *City
*State / Province / Prefecture: *Zip / Postal Code
*Phone: E-mail: Fax:
Mobile Phone 1: Mobile Phone 2:
*First Adult's Occupation:
*Second Adult's Occupation:
*First Adult's Birthdate: *Second Adult's Birthdate:
Please list all children living at home, and any other persons or family members living in the household:
1 .Name: Age: Sex: M F Relationship: 2. Name: Age: Sex: M F Relationship: 3. Name: Age: Sex: M F Relationship: 4. Name: Age: Sex: M F Relationship: 5. Name: Age: Sex: M F Relationship: 6. Name: Age: Sex: M F Relationship:
*Each student requires a private bedroom
*Will student be sharing a bathroom? Yes No No Answer If yes, with whom?
*How long would you be able to host a student?
*Would the student's bedroom have a desk (or table)? Yes No No Answer
*Do you have internet access for a student? Yes No No Answer If yes, what kind?
*Does a student need to bring their own computer to access the internet? Yes No No Answer
*Any other comments on accommodations / facilities?
*Will you permit smoking? Yes Outside Only No No Answer
*Will you permit alcohol in your home? Yes No No Answer
*If your family has pets, please specify type and number:
*Preferences regarding student: Male Female No Preference
*What transportation options (please specify if it is a bus line):
*How long would it take a student to reach the nearest school by public transportation?
*What time do you usually go to bed and get up?
*International travel experience?
*Foreign languages spoken, if any:
*What is your family's religion?
*How did you hear about our homestay program?
*Please give the name and phone numbers of 3 local references: 1 .Name: Phone: Relationship: 2. Name: Phone: Relationship: 3. Name: Phone: Relationship:
*This section is the most important to make a pleasant homestay for both your family and the student. Please tell us why you want to be a host family for an international student, and any comments regarding family interests or hobbies or any other information that will help us to introduce you and your family to a prospective student.
We (OvECS) will make every effort to match a student with your family. However we can not guarantee a perfect match or placement.
By typing your name into the box below, you are signing this application and authorize OvECS to process and research all information provided.
*Signature: (Type Full Name)
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