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Host Family Application
Host Family Background Check
Parental Approval for Off Campus Learning
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Home
» Host Family Application
Host Family Application
Step 1 of 6
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FAMILY INFORMATION: FATHER
Name
First
Last
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Birth Date
MM
DD
YYYY
Home Phone (including area code)
Cell Phone (including area code)
Business Phone (including area code)
Employed by:
Position:
Email
FAMILY INFORMATION: MOTHER
Name
First
Last
Address
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Birth Date
MM
DD
YYYY
Home Phone (including area code)
Cell Phone (including area code)
Business Phone (including area code)
Employed by:
Position:
Email
FAMILY MEMBERS
Please list all children, whether living at home or on their own.
How many children do you have?
*
Select One
0
1
2
3
4
5
Name
*
Age
*
School Attending (or address if not living home)
*
Name
*
Age
*
School Attending (or address if not living home)
*
Name
*
Age
*
School Attending (or address if not living home)
*
Name
*
Age
*
School Attending (or address if not living home)
*
Name
*
Age
*
School Attending (or address if not living home)
*
How did you hear about the Host Family Program at Eastern Christian School?
*
Referred by current EC Host Family
Internet
Name of Host Family who referred you:
*
How many students would you like to host?
*
One
Two
Would you prefer males or females?
*
Male(s)
Female(s)
No Preference
Would you be willing to meet 1-2 times per year with other host parents for the purpose of supporting each other, getting additional training, and giving input to Eastern Christian School for the future of this program?
*
Yes
No
Not Sure
Do you agree to positively support school expectations and work in parenting your host student to do so also?
*
Yes
No
Not Sure
QUESTIONS
Why do you want to be a host family for Eastern Christian School?
What experience has your family had experiencing and adjusting to other cultures?
How do your children feel about the family decision to host a boarding student?
How do you plan to motivate and encourage your boarding student?
Has your son or daughter had any disciplinary difficulty? Please explain.
How do you plan to support your own family’s growth while simultaneously hosting a boarding student?
If you are invited to host a boarding student at Eastern Christian School next year, what factors are important to you in deciding to fulfill the responsibility?
Do you have any concerns about hosting an International Student?
Are you willing to handle any conflicts or challenges that might arise when the boarding student is in your home in partnership with EC while maintaining a high level of confidentiality?
CHURCH/RELIGIOUS AFFILIATION
Home Church
*
Are you:
*
Member
Attending
Denomination:
*
Address
*
Street Address
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Pastor's Name
*
Phone (including area code)
*
Family's Church Attendance
*
Weekly
Frequently
Infrequently
We request that the International Student attend an area church’s youth group during his/her stay. Would this be a problem for you?
*
Yes
No
Not Sure
FAMILY PROFILE
Do you have pets?
*
Yes
No
Please list what type(s) of pets:
*
Are any second languages spoken in the home?
*
Yes
No
Please list what language(s):
*
Will your student have to ride the school bus?
*
Yes
No
How many miles from school do you live?
*
Would you be able to provide a ride for after-school sports?
*
Yes
No
List your family activities and interests:
*
Please think over the basic rules of your household-include as much detail about the duties and responsibilities you will expect from the student. Chores/Responsibilities expected of the student:
*
Curfew for weekdays:
*
Curfew for weekends:
*
Comments on curfews (if any):
STATEMENTS
Our home could be characterized as:
Very Casual
Somewhere in between
Very Structured
Our home could be characterized as:
Active/Noisy
Somewhere in between
Quiet/Studious
Our home could be characterized as:
Rarely Home
Somewhere in between
Homebodies
Comments about your comment (if any):
Our family tends to travel out of the area over holidays and school vacations:
Frequently
Somewhere in between
Rarely
One or more parents tend to travel overnight:
Weekly
Somewhere in between
Never
Each week our family eats dinner together:
7 Nights
Somewhere in between
1 Night
When it comes to cleanliness, our family is:
Neat and orderly
Somewhere in between
Not a priority
The importance of children participating in the chores of the home is:
Written expectations
Somewhere in between
Appreciated
The laundry in our home is primarily done by:
Parent
Somewhere in between
"To each his own"
We anticipate privacy in our home to be:
Need guidelines
Somewhere in between
Not an issue
Computer and internet use in our home is:
Highly regulated
Somewhere in between
Trusted on own
Daily television use in our home is:
No television
Somewhere in between
Usually on when home
How would you describe your children’s attitude toward an international student in your home?
Enthusiastic
Somewhere in between
Willing to try
N/A
How would you describe your normal communication methods with your own children or others?
Confrontational
Somewhere in between
Tendency to avoid
How comfortable are you with allowing teenagers to “challenge” adults?
Never appropriate
Somewhere in between
OK if constructive
When it comes to your children’s standard of dress, how involved are you?
Set guidelines
Somewhere in between
No guidelines
N/A
When your child is out at night, how much supervision do you provide?
Check ahead
Somewhere in between
Trust child to check
N/A
As far as academic expectations, our family has:
Specific grades
Somewhere in between
"Try your best"
Our weekly commitment to church-related activities is:
4 times per week
Somewhere in between
0 times per week
How comfortable are you sharing your personal relationship with Jesus Christ with a teenager?
Excited
Somewhere in between
Not very confident
Any Comments?
REFERENCES
Please list 3 references below whom we may contact in regard to our consideration of your participation in our host family program at Eastern Christian School. Please do not use family as references. Please list people who know your family well.
Three references: Two Character References & Pastoral Reference
Name
*
Relationship to you
*
Phone (including area code)
*
Email
*
Name
*
Relationship to you
*
Phone (including area code)
*
Email
*
Name
*
Relationship to you
*
Phone (including area code)
*
Email
*
HOST FAMILY PICTURES
Your International Student will be very excited to receive photos of your family. Please email pictures to Cathy Lagerveld at cathylagerveld@easternchristian.org of the following: Your Family, Outside of Your Home, Living Room/Den, Kitchen, Bedroom Where Student will Sleep, Bathroom
PARENT SIGNATURES
Date
Mother's Signature
*
Father's Signature