Y.E.S. Homestay Application Form for Host Families

Applicant Information #1

Host Parent #1

Full Name of Host Parent #1 Required

Gender Required

Male

Female

Country of Birth Required

Religious Affiliation Optional

Email Address Required

Cell Phone Number Required

Occupation Required

Current Employer Required

Applicant Information #2

Host Parent #2

Full Name of Host Parent #2 Required

Gender Required

Male

Female

Country of Birth Required

Religious Affiliation Optional

Email Address Required

Cell Phone Number Required

Occupation Required

Current Employer Required

Residence

Home Address Required

Street, City, State, Zip Code

Type of Home Required

# of Bedrooms Required

# of Bedrooms available for Students Required

Children and Other Persons Living in the Household

Please list your children or other persons living in your home. Required

If there is no other person in your home, please write "N/A".

Please list your pets. Required

If you have no pets, please write "N/A".

Household

Please answer the following questions.

Will you provide two or three square meals a day? Required

Yes

No

Have you provide three square meals a day? Required

Yes

No

Would you host a student with a dietary restriction? Required

Yes

No

(ex. Vegetarian)

Have any household members been changed with a crime? Required

Yes

No

If Yes, pleasse describe: Optional

What is the main language spoken in your home? Required

English

Spanish

Other

Multiple choices

We prefer to host a student for Required

Short-term

Long-term

Either

Multiple choices

Our family would like to host a Required

Boy

Girl

Either

Multiple choices

Our family will host a Required

Non-smoker

Smoker

Prefer a non-smoker but will host a smoker

Any additional comments or questions Optional

How did you know about Y.E.S. Homestay? Optional

I understand that the Y.E.S. reserves the right to refuse or remove a host family from the Y.E.S. homestay list if they consider that the host family is not suitable for their program.
I acknowledge that I have read and understand the above application and that I send this form voluntarily.

Notes Required

I understand.