Personal information
Enter your family name here
Enter your full adress here:
Enter your phone number:
Enter your email address here (if any):
Host parent's names:
Host parent's dates of birth:
Host parents' occupations:
Host parents business phone numbers:
Children's names:
Children's dates of birth:
Children's school or occupations:
Children are living at home?
Family host experience
1. Have you hosted an exchange student?
Yes
No
1a. Through which organization?
2. What language is spoken at home?
3. Has anyone in the faimily traveled to another
country?
4. Does anyone in your family smoke?
Yes
No
5. Would you host a student who smokes?
Yes
Maybe
No
6. If yes, what restrictions would be placed on
the student smoking in your home?
7. Do you have houshold pets?
Yes
No
7a. Do they live indoors or outdoors?
Indoors
Outdoors
8. Would you accept a student who is allergic to
animals?
9. Would you accept a student who is allergic to
a specific food?
10. Does anyone in your family have an emotional
or physical disability? Please explain:
11. Has anyone in your family ever been arrested
or convicted except minor traffic violations? Please explain:
12. What is your religion or denomination?
13. How often do you attend religious services?
14. Would you expect your student to attend church
with your family?
15. How would you feel if your student attended
a different church?
16. Why would your family like to host a student?
17. What qualities of your family life would you
like to share with an exchange student?
18. Are you prepared for the emotional and financial
demands involved in
hosting an exchange student?
19. Are you prepared to handle the additional transportation
needs?
20. What expectations do you have of your own children
regarding schoolwork, family responsibilities,
friends and activities?
21. What would you expect of your exchange student?
22. What experience have you had with teenagers
outside your family?
23. What experience has your family had with other
cultures?
24. Describe personalities, interests, hobbies of
each memeber of your family:
25. Describe an ordinary weekday in your household.
Routines, chores, meals, activities:
26. What is a typical weekend like in your household?
27. How are family responsibilities handled? Who
does what?
28. What is your community like? Transportation,
cultural activities, recreational resources, etc.:
29. What is your home like? Size, location:
30. What is the high school like? Location, size,
activities available:
31.For kids only: What are three reasons an
exchange student would like to live with your family?