2017

H O S T FA M I LY A P P L I C AT I O N F O R M

INSTRUCTIONS 1. Please complete the application ELECTRONICALLY. No handwritten applications will be accepted. 2. Attach 4-5 DIGITAL PHOTOS of your family, home exterior, interior living space, student bedroom(s) and pet(s). 3. Kindly submit this application and your photos to [email protected].

HOST FAMILIES ARE REQUIRED TO: • Provide a safe and caring environment for international student(s)

• Provide basic soap, shampoo, laundry detergent etc.

• Provide nutritious breakfast and dinner Monday – Friday, all meals on weekends and school holidays • Treat the student as if he or she were your own child: providing rules, chores, homework guidelines, curfew, etc. • Provide high speed internet access • Provide room with bed, sheets, dresser, desk, and towels

• Assist student with transportation to and from school. If the student takes the bus this will mean drop off and pick-up at the Fairmont bus stop. If the student does not take the Fairmont bus the host will drive the student to and from school. • Host family may need to help student with transportation to special school events

BASIC HOST INFORMATION Father’s Name

Father’s Date of Birth

Mother’s Name

Mother’s Date of Birth

Ethnicity Home Address City State/Province

Zip/Postal Code

Home Phone Number

WeChat ID

Father’s Mobile Number

Mother’s Mobile Number

Father’s email address (Mandatory) Mother’s email address (Mandatory) Are any languages other than English spoken in the home?

YES

NO

If yes, what languages are spoken? When, how often, and under what circumstances are other languages spoken?

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HOST FAMILY INFORMATION Father’s occupation

FULLTIME

PART-TIME

FULLTIME

PART-TIME

MALE

FEMALE

MALE

FEMALE

MALE

FEMALE

Company/Employee name Company/Employee address

City

State/Province

Zip/Postal Code

Business Phone Number

Mobile Number

Mother’s occupation Company/Employee name Company/Employee address

City

State/Province

Zip/Postal Code

Business Phone Number

Mobile Number

List all children and others who reside in the home: Full Name

Gender

Relationship

Date of Birth

Full Name

Gender

Relationship

Date of Birth

Full Name

Gender

Relationship

Date of Birth

Are all family members/others living in the home in good health?

YES

NO

YES

NO

If no, please provide name and conditions Does anyone in the household smoke? Please describe your family

How do you spend your week nights?

How do you spend your weekends?

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Does anyone in the home play a musical instrument, if so please list?

What sports/hobbies/activities do you and your family participate in?

Do you have a pool?

YES

NO

Do you have a piano?

YES

NO

Do you have any pets?

YES

NO

If yes please give details (like breed, size and age) Please attach a picture of your pet(s) Would you be able to host a student who has animal allergies? Your family lives in a

HOUSE

YES

NO APARTMENT/CONDO

TOWNHOUSE

OTHER. PLEASE SPECIFY

Do you own or rent?

OWN

Your house has

BEDROOMS, AND

How many students would you like to host?

RENT BATHROOMS 1

2

3

How many short term/group students are you able to host? (Shared rooms allowed.) Will the student share a bathroom?

YES

NO

Do you have a gender preference?

MALE

FEMALE

NO PREFERENCE

Do you have an age preference

6-8th Grade

9-10TH GRADE

11-12TH GRADE

NO PREFERENCE

YES

NO

YES

NO

If yes, with whom?

Is your family religious?

YES

NO

If yes, what religion? How often does your family partake in religious activities? Would you expect the student to attend services with you? Would you be willing to take students to religious services different than your own? Does your family eat in a way that a host student should be aware of? (kosher, vegetarian) Have you had previous international experience? Have you ever had an international student live with you before? If yes, please explain.

Would you be willing to host a student who is active in extra-curricular activities? (Keep in mind that this will require additional driving on your part).

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STATEMENT OF INTENT Please write a statement to prospective students and their parents. Why have your chosen to be a host family? What are your reasons and hopes? What else explains your decision? Your letter is the most important part of this application. Along with photos of your family and your home, this letter will be the introduction of you and your family and explain why you have decided to host an exchange student. We ask that you be brief yet thorough. Please include all information that might be of importance to your student and his/her parents, such as personalities, background, lifestyle and hobbies.

I attest that the statements made herein are correct as of

Date

Signature

Name

Fairmont Preparatory International Foundation Center admissions processing, recruitment & marketing and global communications are managed and operated in collaboration with University Track Preparation, LLC.

Fairmont Private Schools International Foundation Center 2200 West Sequoia Avenue, Anaheim, CA 92801 E: [email protected] T: +1 714-999-5055

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Fairmont Private Schools | Fairmont Host Family Application Form 2017

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