HOST HOME APPLICATION PROCESS
•
Interested Families o
Complete Host Home Application – See link on web page
Pastoral Reference
Personal Reference •
Background Check •
o •
Someone not employed at VCS All adults living in home over 18 years (no longer in HS)
Home Visit by Int’l Student Program Coordinator
Post-Application Acceptance o
Host Family Questionnaire Filled Out
o
Sent to int’l student to introduce family
Pictures of Host Family & Home
Full family photo; Outside of home; Interior shots of living spaces; Student’s room; etc…
•
Pictures sent with Questionnaire to international student & family
Accepted Host Family Placed on File o
Matched with student who would best fit with the family
o
Male students hosted in the following home types
o
Both gender children, if males in home are similar age to student
Male children only
No children
Female students hosted in the following home types
Both gender children, if student is three or more years older than oldest boy
Female children only
No children
•
Host Home Orientation Meeting/s o
o •
Held at VCS
Host Home Handbook
Contact information of student
Travel itinerary for their student
Student’s medical release information & insurance information
Direct deposit form for monthly stipend
Periodic meetings during the school year for training and support
VCS Administration reserves the right to accept or deny applications from host families
HOST HOME APPLICATION Valley Christian High School’s vision for our international students is that they will observe Christian values in the host home and school; develop their intellectual gifts through academic excellence; build relationships with our students, promoting global and cultural awareness and understanding; and be prepared to return to their passport countries as servant leaders.
Thank you for completing this application. The completion of this application does not commit you to accept a student, nor does it ensure that an international student will be placed in your home, it merely begins the process.
Family Information Address:
_____________________________________________________________________________________________ Street
Father’s Name:
Home Number:
City
State
Zip
_____________________________________________________________________________________ ____________________________________
Cell:
____________________________________
Email:
_____________________________________________________________________________________________
Position:
____________________________________________
Employed by: _____________________________________________________________________________________________ Mother’s Name: Home Number:
Business Phone: ________________________
_____________________________________________________________________________________ ____________________________________
Cell:
____________________________________
Email:
_____________________________________________________________________________________________
Position:
____________________________________________
Employed by: _____________________________________________________________________________________________ Children
Birth date/Age
Gender
Grade School Attending
________________ __
_________
_______ ____________________
_____________________________________
________________ __
_____________________________________
________________ __
_____________________________________ _____________________________________ _____________________________________ _____________________________________
Business Phone: ________________________
________________ __ ________________ __ ________________ __
_________ _________ _________ _________ _________
VALLEY CHRISTIAN SCHOOL
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_______ ____________________ _______ ____________________ _______ ____________________ _______ ____________________ _______ ____________________
Pets
_______________________________________________________________________________________________________ inside/outside the home
Transportation to and from School ______ Personal Vehicle
______ School Bus
______ Other – Please Explain
International Student Preferences We would prefer a
Grade Preference
_________________________________
______ Walking/Biking
______ Carpool
_______________________________________________________________________
______ Male Student ______ Female Student ______ No Preference
______ 9
______ 10
Are you willing to host two students
______ 11
______ Yes
______ 12
______ No
Previous Experience with Internationals: _____________________________________________________________
______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________
______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ Motivation for Hosting an International Student: ______________________________________________________
______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ ______________________________________________________________________________________________________________ _____________________________________________________________________________________________________________
______________________________________________________________________________________________________________ _____________________________________________________________________________________________________________
______________________________________________________________________________________________________________ VALLEY CHRISTIAN SCHOOL
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Please read the following statements and choose a location on the scale provided that best represents your family. Make any additional comments that will help explain your answer. Please note: There is no right or wrong answer. This information is used to help us make the best possible student/family placement and prepare for on-going support throughout the year.
1.
Our home could be characterized as: Very Casual
Very Structured
Rarely Home
Homebodies
Active/Noisy Comments:
Quiet/Studious
2.
Our family tends to travel out of the area over holidays and school vacations:
3.
One or more parents tend to travel overnight:
4.
Each week our family eats dinner together:
Comments:
Frequently
Rarely
Weekly
Never
7 Nights
1 Night
5.
When it comes to cleanliness, our family is:
6.
The importance of children participating in household chores is:
Neat & Orderly
Not a Priority
Written expectations
Appreciated
Daily chores
Weekly chores
Parents
Individual
Need guidelines
Not an issue
Highly Regulated
Trusted on own
7.
The laundry in our home is primarily done by:
8.
We anticipate privacy in our home to be:
9.
Computer and internet use in our home is: VALLEY CHRISTIAN SCHOOL
Host Home Application Page 3 of 5
10.
Daily television use in our home is:
Comments:
No television
Usually on when home
11.
Our family attends church:
12.
Our weekly commitment to church related activities is:
13.
How comfortable are you sharing your personal relationship with Jesus with a teen?
Comments:
Every week
Once a month
4 times/week
0 times/week
Excited
Not very confident
14.
Describe you child/ren’s attitude towards having an international student in your home:
15.
How would you describe your normal communication methods with your own child/ren?
16.
How comfortable are you with allowing teenagers to “challenge” adults?
17.
When it comes to your child’s standard of dress, how involved are you?
18.
When your child is out at night, how much supervision do you provide?
19.
As far as academic expectations, our family has:
20.
Giving rides to and from school and activities will be:
Comments:
Enthusiastic
Willing to try
Confrontational
Tendency to avoid
Never appropriate
Comfortable, if constructive
Set guidelines
Child’s responsibility
Check ahead
Trust child to check in
Specific grades
“Try your best”
Not a problem
Challenging
VALLEY CHRISTIAN SCHOOL
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Church Membership:
_______________________________________________________________________________ Name
We have been members of this church for ________ years.
City
Our Pastor’s name and phone number are:______________________________________________________________ Our Weekly Involvement:
_______________________________________________________________________________
Other Weekly Activities:
_______________________________________________________________________________
_______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ Our family was referred to Valley Christian School’s International Student Program by: A good day and time for a Home Visit from the ISP Coordinator is: M
T
______ Morning
W
Th
F
S
______ Early Afternoon
______ Late Afternoon
Please return completed form to: Valley Christian School Int’l Student Program 3450 Vinland Street
Oshkosh, WI 54901 If you have any questions, please contact: Tara Westpfahl
[email protected] 920-231-9704 x22
VALLEY CHRISTIAN SCHOOL
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______ Evening
HOST HOME APPLICATION PERSONAL REFERENCE FORM Host Family’s Name: __________________________ Personal Reference To be completed by a friend of the family who does not work for the school. The above named family has offered to host an international student in their home for a school year. Please help us find the best placement for our students by responding to the questions below with complete honesty. Your frankness is greatly appreciated, and we will treat your reply confidentially. Please return this form directly to the International Student Program Coordinator at the address given, or email the completed form to the email provided. Thank you! How long, how intimately, and under what circumstances have you known this family?
Would you feel comfortable placing your own child in this family’s home? Please explain.
What are this family’s strengths and weaknesses?
Please comment on why you think this family should or should not serve as a host home family.
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Personal Reference Continued
Host Family’s Name: _______________________________
Are there any ongoing circumstances in the family that the school should know about before placing a student in the family’s home? If yes, please explain.
Do you have any additional comments about this family?
Name (please print): ____________________________________________________________ Signature:
_________________________________ Date
__________________________
Address: ________________________________________________________________________ Street City State Zip Phone (preferred #) ________________________
Email: ___________________________
Please return this form in a sealed envelope to the International Student Program listed below: School:
Valley Christian School Int’l Student Program
Address:
3450 Vinland St. Oshkosh, WI 54901
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HOST HOME APPLICATION PASTORAL REFERENCE FORM Host Family’s Name: __________________________ Pastoral Reference To be completed by someone in spiritual authority over the family. The above named family has offered to host an international student in their home for a school year. Please help us find the best placement for our students by responding to the questions below with complete honesty. Your frankness is greatly appreciated, and we will treat your reply confidentially. Please return this form directly to the International Student Program Coordinator at the address given, or email the completed form to the email provided. Thank you! How long, how intimately, and under what circumstances have you known this family?
Please describe this family’s Christian faith.
Do you think that this family will nurture the spiritual growth of a student placed in their home? Please explain your answer.
Please comment on why you think this family should or should not serve as a host home family.
VALLEY CHRISTIAN SCHOOL Host Home Application ~ Pastoral Reference Form Page 1 of 2
Pastoral Reference Continued
Host Family’s Name: _______________________________
Are there any ongoing circumstances in the family that the school should know about before placing a student in the family’s home? If yes, please explain.
Do you have any additional comments about this family?
Name (please print): _________________________________________________________ Signature:
_______________________________________ Date
____________________
Address: ________________________________________________________________________ Street City State Zip Phone (preferred #) ___________________
Email: ___________________________
Please return this form in a sealed envelope to the International Student Program listed below: School:
Valley Christian School Int’l Student Program
Address:
3450 Vinland St. Oshkosh, WI 54901
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HOST HOME APPLICATION BACKGROUND CHECK AUTHORIZATION, RELEASE & ACKNOWLEDGEMENT The safety and security of students is extremely important to Valley Christian High School (hereafter school). Therefore, it is the school’s policy to run background checks on all host families, volunteers, and employees who will be involved in the international student program. This practice is endorsed by the U.S. Department of State, the Association of Christian Schools International (ASCI), and the Council on Standards of International Educational Travel (CSIET). Please provide the following information for each individual residing in your household who is 18 years or older. Please Print. Please use person’s full legal name. Copy and use additional pages, if needed.
Name ___________________________________________________________________________________________________ First Middle Last SS#
DL#
______________________________________ Date of Birth __________________________________ ______________________________________ State Issued __________________________________
Name ___________________________________________________________________________________________________ First Middle Last SS#
DL#
______________________________________ Date of Birth __________________________________ ______________________________________ State Issued __________________________________
Name ___________________________________________________________________________________________________ First Middle Last SS#
DL#
______________________________________ Date of Birth __________________________________ ______________________________________ State Issued __________________________________
Name ___________________________________________________________________________________________________ First Middle Last SS#
DL#
______________________________________ Date of Birth __________________________________ ______________________________________ State Issued __________________________________
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