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ASU-GNUE Student Teacher Program Host Family Application

All fields marked with an asterisk (*) are required.

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Head of Household (person completing this form)

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Marital Status*
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Provide the following information for all other members of your household.

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Gender
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Gender
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Gender
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Gender
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Gender
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Gender
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Languages

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Are any other languages spoken in the home?
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Accomodations/Preferences

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What are your student preferences for gender?*
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How many students would you like to host?*
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Will you be able to provide the student(s) his/her own bedroom?*
Each student must have his/her own designated bedroom.
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Indicate if the bathroom for student use is:*
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Will internet access/wifi service be provided to the student while in the host home?*
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Meals

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Hosts need to provide food for 2-3 meals per day. Students will eat lunch at the school the days they are on the school campus.

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Can the student use your kitchen to prepare meals?*
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Can you accommodate a student with food preferences, such as vegetarian, does not eat pork, etc?*
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Are there any members of the host family with severe food allergies?*
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Are you prepared to pay for meals eaten outside the home with the student?*
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Transportation

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Students will rely upon the host family for transportation for school related travel throughout their stay.

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Will you be able to provide reliable transportation for the duration of the placement?*
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Do you have current automobile insurance?*
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Students are not permitted to operate a motor vehicle.

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Pets

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Do you have pets?*
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Example: Dog, 12lbs, inside, comfortable with strangers
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Smoking

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Does anyone in your household smoke?*
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If yes, indoors or outdoors only?
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Host Family Interests/Hobbies

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References

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Provide the names, addresses, email address, and phone numbers of two references who have visited your home and know you and the members of your household well. Do not use relatives as references and your application will not be complete without this information.

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Assurances

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Please initial each statement below indicating your acceptance of the terms:

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