Personal Information: Full name as shown on government identification. (You must list all adults and children who will reside in the home for one or more months during the student's stay.)
Contact Information and Location Details
Applicant's Work Schedule * Spouse's Work Schedule
Applicant Highest Level of Education/School * Spouse Highest Level of Education/School
Degree Some High School High School/GED Some College 2-Year College Degree (Associates) 4 Year College Degree(BA,BS) Master's Degree Doctoral Degree Professional Degree (MD, JD) School Degree Some High School High School/GED Some College 2-Year College Degree (Associates) 4-Year College Degree (BA,BS) Master's Degree Doctoral Degree Professional Degree (MD, JD) School
Household Average Annual income (The income data collected will be used solely for the purposes of ensuring that the basic needs of the international student can be met, including three quality meals and transportation to and from school activities) * Does Your Family Receive Needs-Based Government Subsidies for Food or Housing? Less than $25,000   $25,000 - $35,000 $35,000-$45,000   $45,000-$55,000 $55,000-$65,000   $65,000-$75,000 $75,000 or above Yes No
Family Type * Children Not Living at Home
2 Parent Single Parent Single
Description of Your Home
Preferences (Please select one)
I AM   I AM NOT
REGISTERED WITH ANOTHER HOMESTAY PROGRAM. If registered with another Homestay program, I hereby pledge to undertake to inform the same entity to which this application document is being submitted of the presence, gender, age, and country of origin of any other international student I will have in my home during the period under consideration.
Describe your rules and expectations regarding the responsibilities and behavior of the international student while in your home. PLEASE NOTE: A Parent-Student Agreement, signed by each international student and their natural parent(s)/guardian(s), specifically prohibits driving, smoking, and the use of alcohol or any other illegal substances.
Access to food, beverages & snacks *
Household Chores *
Social & Extra-curricular Activities *
Use of Computer/Internet/E-mail *
Other (please specify)
Other (please specify)
Please provide your availability over the next three weeks for our local Residential Coordinator to meet your family and see your home. This typically takes about an hour. Will we call you to confirm a time.
Hosting Types & History
Have you hosted an international student in the past? If so, provide details below.
Summarize why your family would like to host an international student
How did you hear about gphomestay? Please be as detailed as possible (e.g. list the name of the publication or radio station, full name of the person who referred you, etc.).
Can you suggest any other host families? (If the family indicates you as the source of the referral, you will receive $150 for each family that we register into our program.)
Please list two references that may be contacted with regard to your suitability as a host family.
References from work or local community are preferred over close personal friends.
Reference 1 Reference 2
Name * Name *
Relationship to Applicant * Relationship to Applicant *
Address:Street, City, State/ Province * Address:Street, City, State/ Province *
Telephone (555)-555-5555 * Telephone (555)-555-5555 *
Email Address * Email Address *
Occupation * Occupation *
I hereby verify under penalty of perjury that the statements made herein are true and correct to the best of my knowledge. I furthermore authorize criminal background checks to be conducted for each family member over the age of 18 in my household according to the requirements of my state of residence.
I acknowledge that this application in no way guarantees the placement of a student in my home.
(Please include signatures for each family member 18 years of age or older who would be in residence with the student during his/her stay in the home.)
PLEASE NOTE: If your photos exceed 8 megabytes total, you will be unable to submit your application. Before you submit, please first check your photo sizes to ensure that you have not exceeded this limit. If your photos are too large, please e-mail photos as attachments to [email protected], then check the box next to "I will submit my photos later by email them to [email protected]".