TOWER BRIDGE INTERNATIONAL LLC CA
Host Family Application
At Home Family Members (Residents)
1.__________________________________________________________________________________
Last Name
First Name
Middle Name
Date of Birth
Relationship to Host Parent:
__Host Parent
__Son
__Father __Mother
__Daughter
__Grandfather
__Friend __Grandson
__Student/ School Name:___________
__Grandmother
__Granddaughter __Other:_____________________
__Employed/Occupation/Employer Name:_________________
Graduation Level: __High School __2 Year College __4 Year College __Masters __Doctorate __Other:____
________________________________________________________________________________________
Personal Interests and Hobbies (camping, hiking, dance, crafts, debate, drama, art, music, reading, soccer,
baseball, horseback riding)
________________________________________________________________________________________
Member of Organizations and Club
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2. _____________________________________________________________________________________
Last Name
First Name
Middle Name
Date of Birth
Relationship to Host Parent:
__Host Parent
__Son __Daughter
__Grandfather
__Grandmother
__Father __Mother __Friend __Grandson __Granddaughter
__Other:______________________________
__Student/ School Name: ________________ __Employed/Occupation/Employer Name: __________________
Graduation Level: __High School __2 Year College __4 Year College __Masters __Doctorate __Other:_________
____________________________________________________________________________________________
Personal Interests and Hobbies (camping, hiking, dance, crafts, debate, drama, art, music, reading, soccer,
baseball, horseback riding)
____________________________________________________________________________________________
Member of Organizations and Clubs
At Home Family Members (Residents, continued)
3. _________________________________________________________________________________________
Last Name
First Name
Middle Name
Date of Birth
Relationship to Host Parent:
__Host Parent
__Son
__Daughter
__Grandfather
__Grandmother
__Father __Mother __Friend __Grandson __Granddaughter
__Other:_______________________________
__Student/ School Name: ______________________________________________________________________
__Employed/Occupation/Employer Name: _________________________________________________________
Graduation Level: __High School __2 Year College __4 Year College __Masters __Doctorate __Other:______
____________________________________________________________________________________________
Personal Interests and Hobbies (camping, hiking, dance, crafts, debate, drama, art, music, reading, soccer,
baseball, horseback riding)
____________________________________________________________________________________________
Member of Organizations and Clubs
******************************************************************
4. __________________________________________________________________________________________
Last Name
First Name
Middle Name
Date of Birth
Relationship to Host Parent:
__Host Parent
__Son
__Daughter
__Grandfather
__Father __Mother __Friend __Grandson __Granddaughter
__Grandmother
__Other:___________________________
__Student/ School Name: ______________________________________________________________________
__Employed/Occupation/Employer Name: _________________________________________________________
Graduation Level: __High School __2 Year College __4 Year College __Masters __Doctorate __Other:__________
____________________________________________________________________________________________
Personal Interests and Hobbies (camping, hiking, dance,
crafts, debate, drama, art, music, reading, soccer, baseball, horseback riding)
____________________________________________________________________________________________
Member of Organizations and Clubs
At Home Family Members (Residents, continued)
5. __________________________________________________________________________________
Last Name
First Name
Middle Name
Date of Birth
Relationship to Host Parent:
__Host Parent
__Son
__Daughter
__Grandfather
__Grandmother
__Father __Mother __Friend __Grandson __Granddaughter __Other:___________________________
__Student/ School Name: ______________________________________________________________________
__Employed/Occupation/Employer Name: _________________________________________________________
Graduation Level: __High School __2 Year College __4 Year College __Masters __Doctorate __Other:________
____________________________________________________________________________________________
Personal Interests and Hobbies (camping, hiking, dance,
crafts, debate, drama, art, music, reading, soccer, baseball, horseback riding)
____________________________________________________________________________________________
Member of Organizations and Clubs
6. ___________________________________________________________________________________________
Last Name
First Name
Middle Name
Date of Birth
Relationship to Host Parent:
__Host Parent
__Son
__Daughter
__Grandfather
__Grandmother
__Father __Mother __Friend __Grandson __Granddaughter
__Other:___________________________
__Student/ School Name: ______________________________________________________________________
__Employed/Occupation/Employer Name: _________________________________________________________
Graduation Level: __High School __2 Year College __4 Year College __Masters __Doctorate __Other:__________
____________________________________________________________________________________________
Personal Interests and Hobbies (camping, hiking, dance, crafts, debate, drama, art, music, reading, soccer,
baseball, horseback riding)
____________________________________________________________________________________________
Member of Organizations and Clubs
Host Parent Contact Information
________________________
Home Telephone
___________________________ _________________________
Host Parent 1 email
Host Parent 1 Cell Phone
_______________________
Host Parent 1 Work Phone
___________________________ _________________________
Host Parent 2 email
Host Parent 2 Cell Phone
_______________________
Host Parent 2 Work Phone
Residence (Home Description)
__________________________________________________________________________________________
Street
City
State
Zip Code
Is the residence the site of a business (farm, home care, etc.)? __Yes __No
__________________________________________________________________________________________
Number of bedrooms
Number of bathrooms
Primary rooms (kitchen, living, dining, loft, etc.)
__________________________________________________________________________________________
With whom will the visiting student share a bedroom? (no-one or name)
__________________________________________________________________________________________
Working utilities (washer, dryer, internet router, etc.)
__________________________________________________________________________________________
Languages spoken at home (English, Italian, Tagalog, etc.)
__Number of Pets Types of Pets: ________________________________________________________________
What school district is the home residence address area in?____________________________________________
In what type of community do you live? __ Urban __ Suburban __ Rural __ Farm
___________________________________________________________________________________________
What points of interest are near your area (parks, museums, historical sites)?
___________________________________________________________________________________________
Are there any areas in or near neighborhood to be avoided?
(Please attach or include photos of home: exterior and grounds, kitchen, student’s bedroom, student’s bathroom, and
family and living areas.)
Household Financial Resources
(The income data collected will be used solely for the 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)
Annual Average Income Range:
__ Less than $25,000 __ $25,000–$35,000 __ $35,000–$45,000
__ $45,000–$55,000 __ $55,000–$65,000 __ $65,000–$75,000
__ $75,000 and above
Is anyone residing in the home receiving any kind of public assistance (financial needs-based government subsidies
for food or housing)? __Yes __No
Identify those personal expenses expected to be covered by the student:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Diet
Does anyone in the host family follow any dietary restrictions? __Yes __No
If yes, describe:
____________________________________________________________________________________________
____________________________________________________________________________________________
Do you expect the student to follow any dietary restrictions? __Yes __No
If yes, describe:
____________________________________________________________________________________________
____________________________________________________________________________________________
Would you feel comfortable hosting a student who follows a particular dietary restriction (ex. Vegetarian,
Vegan, etc.) ? __Yes __No
Would the family provide three (3) square meals daily and snacks? __Yes __No
Spirituality
Would the host family be willing voluntarily to inform the student visitor in advance of any religious affiliations of
the household members? __Yes __No
Would any member of the household have difficulty hosting a student whose religious beliefs were different from
their own? __Yes __No
(A host family may want the student visitor to attend one or more religious services or programs with the family.
The student visitor cannot be required to do so, but may decide to experience this facet of U.S. culture at his or her
discretion.)
Sports
If applicable list sports/clubs/activities, if any, the host family children participate in at School District of residence:
_____________________________________________________________________________________________
Does any member of your household work for the School District high schools in a coaching/teaching/or
administrative capacity?
__Yes __No
Has any member of your household had contact with a coach regarding the hosting of an exchange student with
particular athletic ability? __Yes __No
If yes, please describe the contact and sport:
Miscellaneous
Describe your expectations regarding the student’s responsibilities and behavior while staying in your home
(homework, household chores, curfew - school night and weekends, access to refrigerator and food, drinking of
alcoholic beverages, driving, smoking, computer/Internet/E-Mail):
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Will the family provide the exchange student with transportation to and from school? __ Yes __ No,
If No, Please explain? ___________________________________________________________________________
Would the family provide special transportation for extracurricular activities after school or in the evenings, if
required? __Yes __No
May we know who referred you to Tower Bridge Homestay Program?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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