ESL Host Family Application

Welcome to the ESL Host Family Application form!
Please fill out the following fields carefully and we'll notify you as soon as possible of your pending application. All information is confidential.
Note: Your application will not be submitted until you have previewed it and then clicked on the "Submit Request" button.
**Please be aware that we are required to run a background check on all families hosting one of our students.**


 
Mother's Information
Last Name First Name
Occupation eMail Address
Cell Phone Work Phone
Father's Information
Last Name First Name
Occupation eMail Address
Cell Phone Work Phone
Family Address
Street & Apt.
City State
Zip Home Phone Number
Information About Your Children
Name Age Sex Living At Home?
Family Details
Please list any special eating habits of your family (80 words max.)
Religious affiliation of
Mother Father Children
Your family's religious involvement
Your family understands that the exchange student has the right to decide if he/she will attend services with your family; religion cannot be forced on the student
Have you ever hosted an exchange student? If so, what agency?
Family Information
Tell us about your family's Hobbies, Interests, Weekend Activities (120 words max)
Please give a brief description of each family member, including his or her interests, responsibilities etc. (120 words max)
Home Environment
Do any members of the family smoke?
If YES, are they smoking inside the house?
Household pets or Animals - Specify number, breed, indoor/outdoor (120 words max)
Additional greetings to your exchange student (120 words max)