Host Parent

Which Area do you Live?*

How did you hear about us?*

Parent One's Name*

FirstLast

Occupation Parent 1*

Parent Two's Name

FirstLast

Occupation Parent 2

Do you have children?*

Yes
No

How many?

How old are they?

What type of residence do you live in?*

How many students can you host at one time?*

Will student have their own room?*

Private Room
Shared Room

Student's room location*

Does anyone in family smoke?*

Yes
No
Outside only

Do you have any pets?*

no
dog
cat
other

Is internet access available?*

International Student preference

How long are you considering hosting a child?*

List activities that family engage in:*

Hobbies and other activities the student can participate in.

Are there any languages other than English spoken in the home? If so list them.

Your Email*

Phone*

Address*

Street AddressAddress Line 2CityStateZip Code

Date of Birth (optional, for background check)

MM

DD

YYYY

(giving your date of birth at this phase in the application process is optional, but it will help speed up the process.)

Date of Birth (Parent 2)

MM

DD

YYYY

By entering your date of birth you are agreeing to allow IBG to run a background check on you.*

I allow IBG to run a background check on me at this time.
I have not entered my date of birth at this time.

Why are you considering hosting a student?*

Optional picture upload-Family photo

Upload family, home exterior and student's room to expedite process. 1 photo per upload under 2 megs.

Bedroom

Kitchen

Home Exterior

Study area

yard

Financial Section

Annual Income *

Host families will receive a monthly stipend for the care of the student.‘‘The income data collected will be used solely for the purposes of determining that the basic needs of the exchange student can be met, including three quality meals and transportation to and from school activities.’’

I attest that the information on this application is true and understand false information will result in denial of participation in IBG's Hosting Program.*

I attest that this information is true!
I authorize my electronic signature to be used as my signature on this application

Name*

FirstLast

Host Parent

Host Parent Application(short term or long term)

Financial Section

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