HAMDEN EDUX Host Family Application

HAMDEN EDUX Host Family Application
Basic Family Information
Your Information
Full name-You*

First NameLast Name
Year of birth
Phone Number*

Area CodePhone Number
E-mail
Preferred Contact Method*
Ethnicity (optional)
Highest Education Degree
Occupation
Working location (city)
Spouse’s Information

(If Applicable)
Full name-Spouse

First NameLast Name
Year of birth
Phone Number

Area CodePhone Number
E-mail
Ethnicity (Optional)
Highest Education Degree
Occupation
Working location (city)
Marital Status of Parents:

MarriedDivorcedRemarriedWidower/WidowedSingle
Children’s Information
Child 1 Full name

First NameLast Name
Age
School
Grade
Child 2 Full name

First NameLast Name
Age
School
Grade
Child 3 Full name

First NameLast Name
Age
School
Grade
Child 4 Full name

First NameLast Name
Age
School
Grade
Home address*

Street Address

Street Address Line 2

CityState / Province

Zip Code
Main contact

FatherMother
Religion (optional)
Home Inquiries
1.Do you have pets?

YesNo
If you answered yes, what kind of animals do you have and how many? Please describe their level of friendliness toward non-family members.
2.Would your international student have their own room?*

YesNo
If sharing a room, with whom?
3.Would your international student share a bathroom?*

YesNo
If sharing a bathroom, with whom?
4.Are you willing to personally drive the student to and from school?*

YesNoOther
4.Do any of your family members smoke?

YesNo
5.Do you have a gender preference for the student?

GirlNo preferenceBoy
6. Please list any other individuals living in your home (other relatives, renters, etc.)
7.What do you hope to gain from having an international student live with your family?
8.Have you ever hosted an international student before?

YesNo
If so, please describe your experience.
9.Questions you have and/or additional information you want to provide to us for why you are qualified to host a student.
Hosting References

Please only list non-family members.
Reference 1
Reference 1-Name*

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Reference 2
Reference 2-Name*

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
How did you hear about HAMDEN EDUX?
THANK YOU for applying to host an international student!

A HAMDEN EDUX staff member will be in touch with you soon.
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HAMDEN EDUX Host Family Application

Basic Family Information

Your Information

Spouse’s Information

Children’s Information

Home Inquiries

Hosting References

Reference 1

Reference 2