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Host Family Application

If you are interested in becoming a host family, please fill out our application.

We provide several programs throughout the year for various groups, so the lengths and commitments for each homestay experience will vary.  We notify all of our host families of upcoming program opportunities via email.

Date of Application:
 /  / 
Last Name: *
Husband Name:
Husband Phone:
Wife Name:
Wife Phone:
Home/Primary Phone Number:
E-mail: *
Occupation Husband:
Occupation Wife:
Were you referred to us? If so, please tell us who referred you:

Please list only children currently living at home:
Child 1 Name:
Gender Child 1:
Current Age Child 1:
Date of Birth Child 1:
 /  / 
Child 2 Name:
Gender Child 2:
Current Age Child 2:
Date of Birth Child 2:
 /  / 
Child 3 Name:
Gender Child 3:
Current Age Child 3:
Date of Birth Child 3:
 /  / 
Child 4 Name:
Gender Child 4:
Current Age Child 4:
Date of Birth Child 4:
 /  / 
List Other Members of Household (e.g. Aunty Momi, Grandpa Jo, Exchange Student Noriko, etc):
Family Interests and Hobbies (e.g. surfing, hiking, shopping, baking, etc):
All Family Pets (specify indoor or outdoor):
We prefer to host:
Brief description of your home (e.g. single family home, 4 bedrooms 2 bathrooms):
Any additional information you would like share:
Hawaii Homestay provides a small stipend
to help cover the cost of gas and food.
This stipend is taxable income and host families
who receive more than $600.00 per year in stipends
will receive a Form 1099 tax document.

Stipend Check made out to: *