Host Family Online Registration

Host Family Online Registration Form


Homestay Florida is actively seeking to attract Host Families to accommodate students who attend The Sagemont School in Weston FL, as well as all Broward College Campus Locations.

Monthly Stipend Provided!

PLEASE feel free to complete our Host Family Online Registration Form to get started!


Applicant/Spouse

Applicant First Name / Last Name: Spouse First Name / Last Name:
Applicant Date of Birth:
(dd/mm/yyyy)
Spouse Date of Birth:
(dd/mm/yyyy)
Residence Type: Bedrooms 
Home Address (complete):
Guard Gated Community? Community Fitness Center (or within walking/biking distance)?
Applicant’s Native Language: Spouse’s Native Language:
Primary Language Spoken in your Home:    * Must Speak ONLY English Around Student
Applicant’s Cell Phone: Spouse’s Cell Phone:
Applicant’s Email: Spouse’s Email:
Applicant’s Employer:
Occupation: Work Phone:
Spouse’s Employer:
Occupation: Work Phone:
Applicant / Spouse’s Facebook URL: Applicant / Spouse’s Skype Account Name:

Please provide the following information for other family members / persons living in your home:

Adult First Name / Last Name : Date of Birth
(dd/mm/yyyy)
Employer: Relationship to Host Family Applicant:
Occupation: Work Phone:
Adult First Name / Last Name : Date of Birth
(dd/mm/yyyy)
Employer: Relationship to Host Family Applicant:
Occupation: Work Phone:
Child First Name / Last Name : Date of Birth
(dd/mm/yyyy)
Child First Name / Last Name : Date of Birth
(dd/mm/yyyy)
Do you have any Pets? If yes, then please provide the following information:
Type Name
Kept
Type Name
Kept
Does anyone in your home smoke? If a student is a smoker, would you permit smoking in a designated area outside of your home?
How many students can you accommodate? I / We prefer

Meal Options & Preferences

Homestay Florida offers our college, university, and language school students 3 home accommodation options depending upon student preference.

HOMESTAY:

3 meals per day (option # 1)
2 meals per day (option # 2)

Breakfast: self-served as agreed upon by student and family.
Lunch: provided by family (option # 1), or by student (option # 2).
Dinner: as served by family - no special requests.

HOME SHARE:

No meals (option # 3)

Kitchen privileges provided daily.
We would welcome any among these accommodation options:  
Each student will require a private bedroom, along with bedding, dresser, closet, desk, wireless internet.
Can you provide this?
Student Bedroom #1 Is there a TV in the bedroom?
Student Bedroom #2 Is there a TV in the bedroom?
Student Bedroom #3 Is there a TV in the bedroom?
Student Bathroom If you would host one student and have selected a Shared Bathroom, then what is the gender of person to be shared with?
What is the walking distance from your home to the nearest public shopping area? What is the walking distance from your home to the nearest Broward Transit bus stop?
Would you be able to provide school transportation?
* This would add to your monthly stipend
Would you be willing to assist student if he/she would need to establish a bank account and/or purchase a cell phone?

Please provide the following information about your family’s interests and routine:

Why would you like to host an international student? Is there beneficial information to know about you or your family in order to make a compatible match?
Please describe yourself and / or your family’s interests: Do you regularly prepare dinner in the evening? What kind of meals do you prepare?
How will you integrate your student in your daily / weekly activities? How did you hear about Homestay Florida’s International Student Program?

Please provide two character references. These must be personal, non-familial references who have known you for at least five years.

Name Phone
Name Phone
I/We acknowledge that I/We understand the importance of speaking only English during the time that my/our student(s) are in our home.
I/We acknowledge that I/we, along with any other adult(s) over the age of 18 living in the home, will be required to submit to a Criminal Background Check prior to student placement. I/We also acknowledge that I/we will notify Homestay Florida if any adult(s) over the age of 18 moves into the home following student placement.
I/We acknowledge that we will be required to complete IRS form W-9 prior to high school student placement. Payment for other students will be provided to us directly from the student, and not from Homestay Florida.
I/We maintain Homeowner’s Insurance or Renter’s Insurance, and I/We agree to ensure that this policy is inclusive of incidents caused by boarders.
I/We acknowledge that I/we will maintain a valid driver’s license and an active auto insurance policy.
I/We have read and understand the Host Family "Homestay Requirements," "Guardian Responsibilities," "Stipend and Conditions," and "Homestay Guidelines" website pages for hosting an international student. I/We also understand and acknowledge that Homestay Florida is not responsible for any accidents, damages or loss incurred by us as a result of negligence of the student and we will negotiate this with the student directly.
Declaration
"I verify that the information on this form is true and correct to the best of my knowledge."
Electronic Signature & Date
 
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