You must have JavaScript enabled to use this form. Personal Info Full Legal Name Date Of Birth Co-applicant Full Legal Name Co-applicant Date Of Birth Contact Info Address City Zip Primary Email Address Primary Phone Cell Phone Family Environment Occupation Primary/Secondary Languages Co-applicant Occupation Co-applicant Primary/Secondary Languages Do you have children? No Yes Children Details List names and birth dates of your children Do you have other occupants? No Yes occupants details Enter names and birthdates of other occupants Description of Home Briefly describe your home (number of bedrooms, bathrooms, social areas, levels, etc.) Description of Student's Room Please describe the room where the student will sleep, location in the home, size, and furnishings. Bus Routes to SPSCC Please list bus routes from home to SPSCC. Upload home photos Please upload two photos of your home. Include one of the front of your home.Maximum 2 files.8 MB limit.Allowed types: gif, jpg, jpeg, png. Do you have Internet? No Yes Do you have pets? No Yes Type of pets? Dietary Practices Please select your family's dietary practices. - None -RegularVegetarianKosherHalalOther Do you attend church? No Yes Type of Church Please describe the type of church and how often you attend. Do you travel internationally? No Limited Extensive International Travel Please list where you have traveled. Household Interests and Hobbies Please list any household interests or hobbies that you would share with a student. Preferences Type of Student Please select one. - None -Male student, but can take female studentFemale student, but can take male studentMale student, cannot take female studentFemale student, cannot take male studentNo preference Number of Rooms Available Each student is required to have their own private room. Hosting Type Please select your preferred hosting type(s) and term. Adult - Long Term Adult - Short Term Minor - Long Term Minor - Short Term Have you hosted an international student before? Please give details. Other Home Stay Program Are you registered with another home stay program? If registered with another home stay program, I agree to inform SPSCC International Student Services of the presence, gender, age and country-of-origin of any international student I will have in my home during the period under consideration for the placement of a student for SPSCC. Related Experience or Training Please describe any related experience or training. Summary of Interest Please summarize why your family would like to host an international student. References Please list two references (non-relatives) with contact information. Host Family Rules Please explain to the student your household rules and personal expectations. It is very important that your student be treated as a member of your family. School Night Curfew Weekend Curfew Phone Use Internet Use Laundry Will instruct student in use of machines Student will not be required to do their own laundry Family Meals Eat together regularly Once a week Other Smoking Do you allow smoking in or near the home? No Yes Other Chores or Expectations Additional Information Please provide any additional comments or information that you would like us to have. Agreement Applicants and their families understand and acknowledge by their signatures that SPSCC maintains jurisdiction over all aspects of the International Student Program. In the event of any problem between the student and the host family, SPSCC will work to resolve the differences. However, we reserve the right to remove the student at any time deemed necessary. SPSCC does guarantee placement. I further understand that SPSCC will perform a background check on all household members over the age of 18. I agree and accept the Home Stay Provider Agreement below. Home Stay Provider Agreement The Home Stay Provider agrees to: Provide breakfast and lunch foods for the student 7 days a week and invite the student to join them for 5 dinners per week that the Home Stay Provider prepares. Commit to a one quarter commitment for hosting any student. Give 30 day written-notice to both the student and the SPSCC Housing Coordinator if for some reason they can no longer host their student. Provide each student with a private room, bed, desk, dresser and/or closet, and Internet. Not offer the student household work in exchange for money or rent reduction. Provide students with their own copy of house keys. Notify the Housing Coordinator if no longer able to be a Home Stay Provider for SPSCC students. Participate in the Home Stay Provider Orientation and other occasional related SPSCC activities. Signature Co-applicant Signature Signature Date
