Form

USAI Host Family Data Form

Complete form below to sign up. You will receive a Thank You message indicating form has been subitted.
Full Contact Name*
First Name Last Name
Which program are you interested in?

Total Immersion Homestay with Day Camp

Contact Address*

How did you hear about this program?*
Please descibe your inerest in hosting an international student.*
Have you hosted before?*

Yes No
Please describe your previous hosting experience, if any.
Are any second languages spoken by family members?*

Yes No
Please describe and indicate the degree of fluency in each language and whether any languages other than English are regularly spoken at home.
Have any members of your family visited a foreign country?*

Yes No
Please describe.

Please describe your hometown (proximity to nearest city, lake, river, park, etc.) Is your home in a suburban or rural area? What's the population and what are your neighbors like?*
Please describe your home.*
Please describe the members of your family.*
Does anyone in your family smoke in the house?*

Yes No Outside only
Do you have pets?*

Yes No
If so, please describe (cat, dog or other, personality, where they sleep, etc.)
Will your international students be sharing a room?*

Yes No
Please describe where your international student will be sleeping.*
Does your family have any special dietary requirements (medical, religious, etc.)?*

Yes No
Please describe.

Please describe your expectations of your international student's behavior during the time he/she is in your home (curfew, cleaning, laundry, downtime, general attitude).*
Please describe a typical summer weekday in your home.*
Please describe a typical summer weekend in your home.*
Does your family practice a religion?*

Yes No
Please describe, and in particular how your family's religious practices form part of your daily or weekly activities.
Does any member of your family have a chronic or serious illness?*

Yes No
If so, please describe.
Does any member of your family have a disability, nervous or mental disorder?*

Yes No
If so, please describe.
Have you or any member of your family (or anyone who might be visitng your home) been charged with or convicted of a crime?*

Yes No
If so, please explain.

USAI Host Family Data Form