School Partners Abroad

This will be sent to students

Host Family Information Form

A. FAMILY DATA
1. Name of host student: Student E-Mail: 2. Names of parents: 3. Address (Number) (Street) (City)

in Japan, please print or type

Student Cell Phone

(State)

(Zip Code)

Telephone Numbers Family Main: ( ) Any you would like to receive text notifications: Family/Parent E-mail:
4. Composition of family at home: Adults (names and relationship to hosting student, eg. stepmother, grandfather, etc.) Sons (names and ages) Daughters (names and ages)

B. FAMILY HABITS AND CUSTOMS

1. Parents Interests Please list any special interests, as well as any clubs, organizations, sport groups, committees, etc. in which you are involved and indicate how much time away from home, if any, each interest or activity may require while you are hosting the visiting student. Mother: Father: Host Student: Host siblings: 2. Fathers occupation: Work phone Cell Phone

3. Mothers occupation:

Work phone

Cell Phone

4. Please answer the following questions. a. Do your children have a curfew? If YES, please indicate time: weeknight b. Do you allow smoking in your home? c. Do you allow your children to drive? d. Does your family follow a special diet (vegetarian, kosher, etc.) which would be important for a prospective guest to know ahead of time? If YES, please describe weekends

C. INTERNATIONAL EXPERIENCE
1. Has anyone in your family lived, traveled, or studied abroad? If so, please describe. 2. What language is spoken at home? 3. Do any family members speak and/or understand any foreign language? If so, please Describe.

D. YOUR HOME
1. Do you live in an apartment or a private house? 2. How far is your home from the school your guest would attend? 3. What means of transportation would normally be used by the visiting student? a. To attend school: b. To participate in other activities during the program: 4. Would the visiting student have his or her own bedroom? (Please note that a separate bed For the visiting student is required, but a separate room is not.) If not, with whom would the student share a room? 5. Does your family have any pets? If so, please specify.

E. THE HOST STUDENT 1. What are the hosting students major interests at school?

2. Does the hosting student participate in any activities outside of school (part-time job, extracurricular activities, music or other lessons, etc.) in which the visiting student would not be able to participate? Please specify and indicate how much time is involved for each activity.

3. What does the hosting student do in his/ her free time? Please check and fill in any which apply. sports: (please list) art/music read listen to music watch TV movies go shopping visit friends entertain friends at home

** If possible, please attach a family photo

Please return this form to the Ms. Cain by January 13, 2013
School Coordinator: Please send this form to the visiting school.
7225 Christian Drive, New Palestine, IN 46163 USA

School Partners Abroad

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