HOMESTAY FAMILY APPLICATION

                                                                                                

Last Name                          First Name:                     Relationship:                       
Last Name                          First Name:                     Relationship:                       

Address                                                   City                       State            

Zip Code:              Phone:                        E-mail:                                           

Fax:                          Mobile Phone 1st:                        Mobile Phone 2nd:                                 

First Adult's Occupation:                              Business Phone :                                           

Second Adult's Occupation :                               Business Phone :                                           

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:

      Name             Sex / Age    Relationship         Interest           Profession or School

1.                                /                                                                                        

2.                                /                                                                                        

3.                                /                                                                                        

4.                                /                                                                                        

5.                                /                                                                                        

6.                                /                                                                                        

7.                                /                                                                                        

8.                                /                                                                                        

 

※Each student requires a private bedroom

Will student be sharing a bathroom? Yes:    No:     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:       

Do you have internet access for a student? Yes:       No:        If yes, what kind?                               

Does a student need to bring their own computer to access the internet? Yes:       No:     

Any other comments on accommodations / facilities?                                                           

Will you permit smoking? Yes:      Outside only:       No:       

Will you permit alcohol in your home? Yes:       No:     

If your family has pets, please specify type and number:                                                     

Preferences regarding student; Male:     Female:     No Preference     Nationality:                                        

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 names and phone numbers of 3 local references

Name :                           Relationship:                      Phone:                       

Name :                           Relationship:                      Phone:                        

Name :                           Relationship:                      Phone:                       

 

※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 signing your name below, you attest that all the information above is true and accurate to the best of your knowledge.

 

Signature                                                           Date      /      /