host-family-application

All prospective host families are required to submit the following form. You will be contacted by a representative of

Hawaii Homestay for a further interview by telephone or in person. Please only list children currently living in the home.

HOST FAMILY APPLICATION

Date of Application

Family Name

Husband Name

Wife Name

Address

City

State

Zip

Home Phone

Occupation Husband

Husband Cell Phone

Occupation Wife

Wife Cell Phone

Child 1 Name

Male

Female

Age

Date of Birth

Child 2 Name

Male

Female

Age

Date of Birth

Child 3 Name

Male

Female

Age

Date of Birth

Child 4 Name

Male

Female

Age

Date of Birth

List Other Members of Household

Family Interests & Hobbies

INDOOR Family Pets (specify)

Long term (one month or longer) preferred

Short term (less than one month) preferred

Boy preferred

Girl preferred

No preference as to gender

Non-Smoker preferred

Smoker okay (outside)

Brief Description of your House

Any Additional Information?

Make Stipend Check payable to