Weekend Host Family Application Form for the ELI at OSU

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Weekend Host Family Application Form

Please make sure you have you have read the Host Family Agreement before filling out this form.
Your Name:
Address:
Phone Number:
Work Phone:
Occupation:
Email:
Spouse's Name:
Spouse's Occupation:
Spouse's Work Phone:
Spouse's Email:
Do you have children at home?	Yes No
If yes, please write in their names, ages, and gender
Special Notes (will any special clothing or items be needed for special activities?)
Hobbies, interests, talents or special activities that you and your family have or enjoy:
Pets (type and size):
Are they indoor, outdoor, or both?	Indoor Outdoor Both
Does anyone in your home smoke?	Yes No
Are you vegetarian?	Yes No
Student preference:	Male Female Either
Could you host 2 guests if necessary?	Yes No
Is smoking outdoors by students ok?	Yes No
Describe your sleeping arrangements for guests:
Have you had previous international experience?	Yes No
If yes, please explain:
Please explain why you would like to be a homestay host:
The ELI can provide a small stipend to help offset expenses. Would you like to receive the stipend?	Yes No
If yes, we must have the name and social security numbers of adult members of the household to process payments:
Please list two references (excluding family members) that we may contact:
Contact 1
Name:
Address:
Relationship:
Phone Number:
Contact 2
Name:
Address:
Relationship:
Phone Number:

I have read the Host Family Agreement on the previous page, and I understand and agree to the guidelines set forth by it. Yes No

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