1. Personal Information

We are:
First Name: Last Name:
First Name: Last Name:
Address Apt/Condo #
City State
Zip Code: Home Phone:
Work Phone: Cell Phone:
Email: Confirm Email:

2. Family Details

(Mr.) Host Occupation and name of Company:
(Ms.) Host Occupation and name of Company:
Please list all children, OR other family members/ non-family members (borders, students) living in the home.
Name Male/Female Relationship Age
Are all family members/ others living in the home in good health?

If no, please explain:

3. Accommodation Details

Housing Type:
Do you have a backyard pool?
Community Pool?
Internet Service is Mandatory for our Participants at no additional charge:
Do you have internet service available for a Participant?
Is it wireless?
Does the room have Cable/Satellite TV?
Does it have a private bathroom?
Do you have laundry available in the home for a Participant?
Student Preferences:
How many Participants can you host in private rooms?
Would you be willing to provide Breakfast and Dinner for the Participant?
(Breakfast is student prepared and dinner is prepared by the host at least 4 nights of the week)
Are you a Vegetarian?
Do you have pets in the home?
If Yes, please describe:
Are the pets kept:
Do you have parking available if a Participant has a car?
If yes, Please describe (street, garage, driveway):
Is a parking permit required?
What is the distance in miles to the nearest bus/Metro stop from your home?
Please list the names of any schools your home is near to (please refer to our list of school on our homepage):
School #1: Distance:
School #2: Distance:
School #3: Distance:
Please list any bus lines you may know about:

4. Other Details

Have you ever hosted a person in your home from another country?
If yes, please explain?

Have you ever traveled to another country?
If yes, please explain:

Please describe your hobbies and interests:
If you are chosen to Host an IHPS Participant, how will you integrate him/her into your/family life?
Why would you like to host a Participant in your home?
Please provide two character references (excluding family members):
Name: Name:
Phone: Phone:
Relationship: Relationship:

5. Undertaking

**Please be as accurate and explanatory as possible on your application. We will confirm receipt of your application by email and notify you once we have a Host need for your area. A housing coordinator will come to your home to interview you, see the room and answer any questions you have about our program. He or She will also take a digital photograph of the room and you or your family to include in your host profile. Please feel free to list your Homestay availability on our sister site www.worldhomestay.com
I have read,  understand and accept the IHPS Hosting Agreement [pdf].
(Please print a copy for your records)
Today’s Date: Electronic Signature: