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 (FULL ADDRESS): |
|
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 |
|
Language School Student Accommodation 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 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 |
|
|
|
Should you have any questions regarding Hosting or the Registration process, please feel free to text Beth McMahon at 954.650.3668.