Host Family Application - Thiel College

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Thank you for interest in hosting an international or exchange student from Thiel ... Ensure at all times that the stude
Host Family Application Thank you for interest in hosting an international or exchange student from Thiel College. Please provide the information below. Please be assured that all information will be held in the strictest of confidence. Family Information Family Name: ___________________________________________________________________________________________________________________ Current Street Address: ________________________________________________________________________________________________________ City: ___________________________________________________

State: ____________

Zip Code: _______________________________________

Home Phone Number: _____________________________________________________ First Parent’s Full Name: _______________________________________________________________________________________________________ Cell Phone: ________________________________________ Email Address: ________________________________________________________ Driver’s License Number: __________________________________________ Issuing Date: ________________________________________ Social Security Number: _____________________________________________ D.O.B: ______________________________________________ Occupation: __________________________________________________________________________________________________________________ Company Name: _____________________________________________________________________________________________________________ Contact Person: _______________________________________ Contact Number: _________________________________________________ Second Parent’s Full Name: _____________________________________________________________________________________________________ Cell Phone: ________________________________________ Email Address: ________________________________________________________ Driver’s License Number: __________________________________________ Issuing Date: ________________________________________ Social Security Number: _____________________________________________ D.O.B: ______________________________________________ Occupation: __________________________________________________________________________________________________________________ Company Name: _____________________________________________________________________________________________________________ Contact Person: _______________________________________ Contact Number: __________________________________________________ Please list full name and date of birth for anyone else living in your home. For adults 18 and over, please provide driver’s license numbers. Name

DOB (MM/DD/YYYY)

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Sex

Relationship

Driver’s License #

Please provide three professional references for the responsible parent(s): Name

Address

Phone Number

Relationship

What would be your preference regarding gender? The students will generally be from Asia. Preference: Male _______

Female _______

Country: _________________________________________________

If you know who you would be interested in hosting please identify: __________________________________________________ For the following questions, you may answer in the spaces provided or attach to end of application on a separate sheet of paper. 1. Please describe your Home Environment.

2. What accommodations are available in your household?

3. What community involvement do you and your family partake in?

4. What are some of your family’s hobbies and activities?

5. Have family members lived or traveled abroad? If yes, what countries?

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6. Please indicate foreign language background, if any, for family members.

7. Please describe other hosting experiences you have had.

8. Please state why you would like to host a Thiel College student and what expectations you have for this experience.

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Host Family Commitment      

Attend the Host Family Orientation meeting on August 20, 2011 prior to arrival of the students. Ensure at all times that the student(s) are with an adult who will provide conscientious guidance. Show respect for the students, as well as their culture and rich traditions. Try to learn some of the student’s words and phrases, and help the student learn more English, to improve communication. Enlist the help of the Director of International Student Affairs if there are questions or problems that need their assistance. Do not take the student out of the United States without permission from the Director of International Student Affairs.

I/We have read the above Host Family Commitment and understand our responsibilities. I/We give the Director of International Student Affairs of Thiel College permission to contact my/our listed references. I/We am/are voluntarily releasing the information above to Thiel College in order to verify my identity for purposes of its background investigation process.

______________________________________________________________________________ Host Parent

_____________________________________ Date

______________________________________________________________________________ Host Parent

_____________________________________ Date

Please mail the completed Host Family Application to: Shannon Reesh Director of International Student Affairs Thiel College 75 College Avenue Greenville, PA 16125 Once the application and the Consent & Disclosure Form are received, a screening process will begin and an interview conducted. Requirements for the interview are: 1) application must be complete; 2) all members of the family are requested to be present; 3) interview must be completed prior to student assignment. This application will be held in the strictest confidence by the International Student Affairs Office. The Director will notify you of the status of your application once the review and screening process are completed.

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