Form HF-1: Host Family Application
Host families usually host a SEED student between nine months to one year. The completion of this application
does not guarantee that a SEED student will be placed in your home.
Applicant 1 (Ms – Mrs. - Mr.)
Name:
Last
Phone #: (____)
First
Middle
(____)
Day
Evening
Applicant 2 (Ms – Mrs. - Mr.)
Name:
Last
Phone #: (____)
First
Middle
(____)
Day
Evening
Home Address:________________________________
Street
___________________
City
Name of each person living in the home (add page if necessary)
_____
State
Relationship to you
Zip
Gender M/F
Age
Employment Information
Applicant 1
Applicant 2
Occupation
Name of Employer
Street Address
City, State
Phone & area code
E-mail Address
Work Schedule
(e.g: 8-5pm, 6-9pm)
If this job involves overnight travel, how much? __________________________________________________
HF-1
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Form HF-1: Host Family Application
Second job, if applicable:
Applicant 1
Applicant 2
Occupation
Name of Employer
Street Address
City, State
Phone & area code
E-mail Address
Work Schedule
(e.g: 8-5pm, 6-9pm)
If your second job involves overnight travel, how much?
Living Arrangements
Will the SEED student have a private bedroom?
Yes
No
If “No”, with whom will the SEED student share a bedroom?
Name: _________________________ Age: ______
Sex: _____M _____F
Will the student have his/her own study space?
Yes
No
Will the student have access to the kitchen?
Yes
No
Will the student have access to home laundry facilities?
Yes
No
Yes
No
Transportation
1. Is public transportation (bus) available from your home to the College?
If yes, what is the approximate time of the commute: ______ hours ______ minutes
2. SEED students are not allowed to drive while in the United States. If public transportation (bus) is not
available from your home to the College, will you provide the student transportation to and from the
College on school days?
Yes
No
3. Are you willing and able, on occasional evenings or weekends and with appropriate advance notice, to
ensure that the student gets to and from various program activities?
Yes
4. If you have pets, what kind and how many?
HF-1
No
Occasionally
_______________________________
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Form HF-1: Host Family Application
5.
Does anyone in your family smoke?
Yes
No
6. Would you permit a student to smoke in your home?
Yes
No
7. Would you permit a student to smoke outside your home?
Yes
No
8. Has your family hosted an international student before?
Yes
No
If “Yes”, when, for what organization, and for how long?
9. Please indicate your religious affiliation, (Optional) _________________________________________
10. How often does your family attend? (Optional) _____________________________________________
11. Would you accept a student of a different religion from that of your family?
Yes
No
12. Would you accept a student who does not wish to attend religious services with your family?
Yes
No
13. Is the student's ethnic background of any concern to you?
Yes
No
14. Is English the primary language spoken in your house?
Yes
No
15. Is Spanish or French spoken in your home?
Yes
No
o
If “Yes”, are you willing to speak primarily English to the student to help the student learn English?
Yes
No
16. What activities and interests are most important to you and your family members?
1) ________________ 2) ________________ 3) ________________
4) ________________ 5) ________________ 6) ________________
Hosting Preferences
17. Please indicate your student hosting preferences: Gender: Male
Female
Either
Countries (list): _______________________________________
18. SEED generally depends on families hosting students for a minimum of nine months. If you could serve as
a temporary host family (less than 9 months), how long would you be interested in hosting?
______________________________________________________________________________________
19. How did you hear about SEED? ____________________________________________________________
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Form HF-1: Host Family Application
Personal Statement
20. Please briefly explain how a SEED student would benefit from living in your home:
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
21. Please briefly explain why you are interested in hosting a SEED student.
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________
HF-1
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Form HF-1: Host Family Application
References
22. Please list AT LEAST two references who have known your family for a minimum of three years and
whom the College may contact. References must be members of your community, and cannot be relatives.
Reference No.1
Name: ________________________________________________________________________________
Address: ______________________________________________________________________________
City: ______________________________
Telephone:
State: _______________________ Zip:_______________
(______)_____________________
Relationship to you: __________________________
Reference No.2
Name: ________________________________________________________________________________
Address: ______________________________________________________________________________
City: ______________________________
Telephone:
HF-1
State: _______________________ Zip:_______________
(______)_____________________
Relationship to you: __________________________
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Form HF-1: Host Family Application
OPTIONAL INFORMATION
Involving the Student in Family Activities
The homes of Host Families are where SEED students learn to speak English, experience U.S. culture, and
build self-confidence. Briefly describe the sort of activities you plan to share with your student that might help
students achieve these objectives. (Here is an example)
weekdays
Mornings
Family and students share breakfast
and morning conversations. We
prepare sack lunch and walk to bus
stop together.
Evenings
Prepare dinners together. Practice speaking
English at the dinner table. I occasionally help
student with their homework.
weekends
Share breakfast and lunch together.
Ask student to join family in
helping with home chores
Invite student to church services on Sunday
mornings. We make a visit to the city park in
afternoon.
Mornings
Evenings
Weekdays
weekends
Consent and Disclaimer
I (We) understand that my (our) application does not mean that I (we) will be assigned a SEED student, nor
does it commit me (us) to accepting a student.
By singing this Host Family Application, the Host explicitly consents to a criminal background check and a sex
offender screening (at the local, state or federal level, as requested by SEED) on behalf of him/her and all adults
and children over the age of 15 residing in the home, as listed below:
I (We) certify that the information provided in the Host Family Application above is true and accurate.
__________________________________
Applicant's Signature
___________________________
Date
__________________________________
Spouse's signature
___________________________
Date
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