• Demographics

• Full Name Parent #1*
  First NameLast Name
• Email Parent #1*
  [email protected]
• Cell Phone Parent #1*
  Please enter a valid phone number.
• Full Name Parent #2
  First NameLast Name
• Email Parent #2
  [email protected]
• Cell Phone Parent #2
  Please enter a valid phone number.
• Address*
  Street Address

  Street Address Line 2

  CityState / Province

  Postal / Zip Code
• Occupation Parent #1*
• Occupation Parent #2
• Please list children and all others living in your home: full name, birthdate, gender, relationship, occupation, and whether this is their permanent residence. If there are none, please indicate as such. *
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• References

• Reference #1 - Full Name/Relationship*
• Reference #1 - Address*
• Reference #1 - Number of Years Known/ Phone Number/Best Time to Contact *
• Reference #2 - Full Name/Relationship*
• Reference #2 - Address*
• Reference #2 - Number of Years Known/ Phone Number/Best Time to Contact *
• Reference #3 - Full Name/Relationship*
• Reference #3 - Address*
• Reference #3 - Number of Years Known/ Phone Number/Best Time to Contact *
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• Home Life

• What languages are spoken at home?*
• Does anyone smoke inside of the home?*
  YesNo
• How would your family feel about accepting a student who holds customs and practices traditions that are different from your own?*
• Does your family practice religion?
  YesNo
• If yes, what religion?
• Would you expect the student to attend religious services regularly?
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• Pets

• Does your family own pets?*
  YesNo
• If yes, list them and state whether they live inside or outside the home.
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• Dietary

• Please describe any special dietary habits that your family follows (gluten-free, vegan, etc.). Would you require your host student to follow this diet as well?*
• How would your family feel about hosting a student with dietary habits different from yours (vegan, gluten-free, etc.)?
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• Hosting Experience

• Has your family hosted an International Student before?*
  YesNo
• List the country and date for each student you have previously hosted.
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• General Home Questions

• Will the student have his or her own room?*
  YesNo
• Can you provide a quiet study area?*
  YesNo
• Do you feel your family is financially able to support an international student living in your home?*
  YesNo
• Please tell us about your family. How would you describe the personality of your family? Do you have any special interests you pursue such as sports, travel, the arts, etc?*
• Are there any health concerns in the family (whether related to physical or mental health) that could potentially impact the home situation of a host student?*
• Please describe your daily routine as a family. Is there a time of year that is particularly busy for your family?*
• If the student wanted to participate in after school activities would you be able to accommodate their transportation?*
  YesNo
• What family household chores would you expect your student to perform regularly?*
• Do you need to have Lake Ridge Academy transportation (Note: the bus does not wait for after school activities)?*
  MorningAfternoonBothNone
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• Background Information

• Have you or any member of your household ever been convicted of a felony?*
  YesNo
• If yes, please explain the circumstance:
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• You are almost done!

• Do you know of other families who might be interested in hosting an International Student?
• Would you be willing to host a student short term when the current host family cannot (vacations, work trips, etc.)? If so, do you have limitations as to what type of student (gender, etc.)?
• I/we understand that as host parents I/we are not the legal guardian(s) of the International Student living in my/our home and that the student’s natural parents solely retain this authority. I/we certify that my/our answers are true and complete to the best of my/our knowledge. *
  Type Full Names Here
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