PARENTS

Parent One

First Name

Last Name

Parent Role

Parent Phone

Phone Type

Cell Home

Email

Employer

Position

Work Phone

Parent Two

First Name

Last Name

Parent Role

Parent Phone

Phone Type

Cell Home

Email

Employer

Position

Work Phone

ADDITIONAL INFORMATION

Host Family Surname

Home Address

City

Zip Code

Home Phone

Home Insurance

Do you have regular homeowner's insurance (fire, theft, etc.) on your home?

Yes No

Acknowledge

We acknowledge that all costs related to hosting a student may not be covered by the homestay stipend, and we are comfortable incurring such costs.

Yes No

Stipend

Would you prefer receiving your stipend as a monthly check or as tuition remission for your own GRCS student?

Monthly Check Tuition Remission

CHILDREN IN THE FAMILY

Children

Please select the number of children in the home.

1st Child

First Name

Age

Gender

Female Male

Grade Level

Please select the current grade, or highest grade level this child has completed.

Employed

Yes No

Lives at home

Yes No

HOME

Residents

Please select the number of additional residents in the home.

1st Additional

First Name

Age

Gender

Female Male

In school

Yes No

Employed

Yes No

Family members with chronic illnesses, disabilities, or disorders.

Name

Condition

Please provide a brief description of condition(s).

Name

Condition

Please provide a brief description of condition(s).

Name

Condition

Please provide a brief description of condition(s).

Pets

We have the following pets in our home:

Transportation

If an international student is placed in our family, he/she will get transported from school by

School bus Family transportation Walking/biking Other (please explain)

Approximate distance to school

Your Family

How would you describe your pace of life, interests, and adaptability?

HOSTING

Student Preferences

We would prefer a:

male student female student no preference

Other Info

Give other information that you think would be helpful in selecting a student for your family. what activities do you hope he or she would enjoy with your family?

Your Family as Hosts

Please explain why you would like to host an international student.

What is your experience in hosting international students?

FAITH COMMITMENT

Father

Please describe your spiritual journey

Mother

Please describe your spiritual journey

Church

What church does your family attend?

Church Involvement

Please describe your involvement in the church.

Spiritual Growth

How will you nurture the spiritual growth of an international student placed in your home?