La Salle College Preparatory Host Family Application

Host Family Application

La Salle College Preparatory Homestay Program
Your Name:

First NameLast Name
E-mail:
Phone Number:
Primary Phone NumberFormat: (000) 000-0000.
Family Information
Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Family Type

Other
How many adults (age 18+) in your family including yourself?
How many minors (younger than 18) in your household?
Association with La Salle College Preparatory
Association with La Salle
If you are a current La Salle parent, what is your student's name?

First NameLast Name
If you are a current La Salle parent, what is your student's graduation class?
Host Parent(s) and Other Family Members Over 18

Please list all family members who are 18 and above
Main Contact Person (Adult #1)
Name

First NameLast Name
Gender
Date of Birthday

MonthDayYear
Phone Number
Format: (000) 000-0000.
Email
Are you currently employed?
Employer
If this question does not apply to you, please put N/A in the box provided
Position
If this question does not apply to you, please put N/A in the box provided
Education
What is the highest degree or level of school you have completed? If currently enrolled, highest degree received.
Adult #2
Name

First NameLast Name
Gender
Relationship with the Main Contact Person (Adult #1)
Date of Birthday

MonthDayYear
Phone Number
Format: (000) 000-0000.
Email
Are you currently employed?
Employer
If this question does not apply to you, please put N/A in the box provided
Position
If this question does not apply to you, please put N/A in the box provided
Education
What is the highest degree or level of school you have completed? If currently enrolled, highest degree received.
Adult #3
Name

First NameLast Name
Relationship with the Main Contact Person (Adult #1)
Gender
Date of Birthday

MonthDayYear
Phone Number
Format: (000) 000-0000.
Email
Are you currently employed?
Employer
If this question does not apply to you, please put N/A in the box provided
Position
If this question does not apply to you, please put N/A in the box provided
Education
What is the highest degree or level of school you have completed? If currently enrolled, highest degree received.
Other Adults
If there are other adults in your family, please list their name and relationship with the main contact person in the text box
Members of the Household Under 18 Years of Age
Minor #1

First NameLast Name
Gender
Age
Minor #2

First NameLast Name
Gender
Age
Minor #3

First NameLast Name
Gender
Age
Other Adults
If there are other adults in your family, please list their name and relationship with the main contact person in the text box
Family Data
Has any member of your household ever been convicted of any crime?
Do you have the experience hosting visiting students before?
Do you currently have visiting students in your family?
Do you prefer to host a male or female student?
Financial Resources

Note: The income data collected will be used for the sole purposes of ensuring that the basic needs of the exchange students can be met, including three quality meals and transportation to and from school activities.
Average Annual Income Range
Does anyone residing in the home receive any kind of financial needs-based government subsidies for food or housing?
If yes, please describe
Family Language, Activities, & Household Guidelines
What is the primary language spoken in your home?
Is there a secondary language spoken in your home?
Which family interests and activities are your family involved in? Check all that apply:
Are you willing to voluntarily inform the exchange student in advance of any religious affiliations of household members?
If yes, please describe affiliation
Would any member of the household have difficulty hosting a student whose religious beliefs were different from their own?
If yes, please describe
How often do you attend religious services?
Note: A host family may want the exchange student to attend one or more religious services or programs with the family. The student cannot be required to do so, but may decide to experience this facet of U.S. culture at his or her discretion.
Home Description
Type of Home

Other
Can you provide a private bedroom to the student you are hosting?
Please upload photos of your house to share with your potential matching students (Home exterior and grounds, Kitchen, Student Bedroom, Living Room, and Family Photos, etc.)

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Household Pets
Do you own any type of pets in your household?
If yes, please describe and specify the amount of pets you own
Diet
Does anyone in the family any dietary restrictions?
If yes, please describe
Do you expect the student to follow any dietary restrictions?
If yes, please describe
Would you feel comfortable hosting a student who follows a particular dietary restriction (For example, Vegetarian, Vegan, etc)?
Please note that the host family is expected to provide the international student with three meals daily. Weekends can be exceptions (e.g. brunch is an acceptable option)
Host Family Personal Letter to Student(Optional)
Please take a moment to write to your potential exchange student. You may include information about your community, family, and local school; your expectations and excitement about the experience, and other information that you feel might be of interest to the student when they learn about you.
Signature
Please contact Mr. MJ Mao, Director of Global Programs, if you have any questions regarding the homestay program.

MJ Mao

Office: 626-696-4363

Email: mjmao@lasallehs.org
Should be Empty:

Host Family Application

Family Information

Association with La Salle College Preparatory

Host Parent(s) and Other Family Members Over 18

Main Contact Person (Adult #1)

Adult #2

Adult #3

Members of the Household Under 18 Years of Age

Family Data

Financial Resources

Family Language, Activities, & Household Guidelines

Home Description

Household Pets

Diet

Host Family Personal Letter to Student(Optional)