Host Family Application :: STS Foundation

Host Family Information

Host Parent 1:

First Name:

Middle:

Last Name:

Age:

Host Parent 2:

First Name:

Middle:

Last Name:

Age:

Home Address:

Street:
City:		State:		ZIP:

Home Phone:			Cell Phone:			Fax:
Work Phone:			Email:

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Host Family Information

Parent 1 Employer:

Parent 2 Employer:

Street:						Street:
City:		State:		Zip:		City:		State:		Zip:

Occupation:		Occupation:
How Long:		How Long:

Airport Name:

City & State:

Airport Code:

Preferred Arrival Date:

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Children Information

Name	M/F	Age	At Home?	Main Interest/Hobby
	Male Female		Yes No
	Male Female		Yes No
	Male Female		Yes No
	Male Female		Yes No
	Male Female		Yes No

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Other Persons Living in the Home

Name	M/F	Age	Relationship to you
	Male Female
	Male Female
	Male Female

Does anyone else have access to your home?

Yes No

If yes, who?

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About your Family, Home and Community

Family Religious Affiliation

Frequency:

Rarely

Sometimes

Regularly

Will you require your student to attend?

Yes

Optional

Would you accept a student who practices a different religion?

Yes

Does anyone in the family smoke?

Yes

If yes, where?

Would you accept a student who smokes?

Yes

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About your Family, Home and Community

Do you have pets?

Yes

What Type?

Kept Where?

Would you be willing to host a student who has allergies to animals?

Does your family follow a special diet?

Yes

Would you be willing to accept a student who is vegetarian or has some eating restrictions?

Yes

If yes, please explain?

235 Chars

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About your Family, Home and Community

What foreign languages do you speak, if any?

List activities and interests of family members:

Please describe your family environment (easygoing, serious, quiet, communicative, liberal, individual, family-oriented, etc) 390 Chars

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About your Family, Home and Community

Describe a typical weekday for your family 390 Chars

Describe a typical weekend for your family 390 Chars

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About your Family, Home and Community

Does any family member have a serious illness, disability, nervous or mental disorder?

Yes

If yes, please explain:

235 Chars

Is your family currently receiving any type of public assistance? (ie. Welfare, Food Stamps Etc)

Yes

If yes, please explain:

235 Chars

Has any family member been convicted of a felony?

Yes

If yes, please explain:

235 Chars

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About your Family, Home and Community

Does any family member own a gun?

Yes

If yes, who?

How is it secured?

Have you hosted in the past?

Yes

If yes, when did you host?

Name of Organization

How was your experience?

What does your family hope to gain from this experience? 390 Chars

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About your Family, Home and Community

Will the student share a room?

Yes

If yes, with whom?

Is your home?

Single Family

Condo

Apartment

Other

Please Specify

Do you rent or own?

Rent

Own

How Long have you lived at this address?

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About your Family, Home and Community

Please describe your home 390 Chars

Describe your community 390 Chars

What are the types of activities and points of interest for teenagers in your community 390 Chars

How did you hear about STS Foundation?

What is the name of your local newspaper?

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High School Information

Name

Address

City

State

Zip

Principal's Name

Approx. Student Population

Principal/School Email

Distance from home

Method of Transportation

Will transportation be available for extra curricular activities?

Yes

Please Explain

235 Chars

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References

Please enter three non-relative references

	Reference Name	Relationship	Phone Number
1.
2.
3.

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Host Family Letter

Please write in the space below a letter to your student that describes your family, including your interests and activities. Don't forget to mention all the members of your household as the student will want to be informed about everyone. 1200 Chars

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Attach Files For Upload

Please attach up to 4 photos of you, your family and home. If you have any trouble uploading photos please email them to hfapplication@stsfoundation.org or call 1-800-522-4678 for further assistance. (PDF files, word documents, or pictures)

File 1: File 2:

File 3: File 4:

Please complete Area Representative and Regional Coordinator fields if known

Area Representative: Name: Phone: Email:

Regional Coordinator: Name: Phone: Email:

Thank you for taking the time to complete this application!

STS Foundation will conduct background checks on all persons 18 and older living in the home as per Department of State regulations. To complete this application and send it to us, accept the Terms & Conditions and click the Submit button below.

Host Parent 1
First Name:	Last Name:	Date:	MM/DD/YYYY
Host Parent 2
First Name:	Last Name:	Date:	MM/DD/YYYY

By Checking this Box we agree to adhere to the regulations of STS Foundation and Department of State.

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