Compass USA | Homestay For International Students

Host Family Phone Number

Host Family Email Address

Host family Address

Host Family City

Host Family State

Host Family Zip

Host Family Mailing Address (If Different Than Street Address)

Number Of Year That The Host Family Have Been At This Address

Previous Address (If Less Than 3 Years)

Host Father First Name

Host Father Middle Name

Host father Last Name

New Field:

Host Father Age

Host Father Occupation

Host Father Work Phone

Host Father Cell Phone

Host Mother First Name

Host Mother Middle Name

Host Mother Maiden Name

Host Mother Last Name

Host Mother DOB MM/DD/YYYY

Host Mother Age

Host Mother Occupation

Host Mother Work Phone

Host Mother Cell Phone

Additional Family Members First Name

Additional Family Members Middle name

Additional Family Members Last Name

Additional Family Members Gender

Additional Family Members Age

Additional Family Members DOB MM/DD/YYYY

Additional Family Members Interests

2. Additional Family Members First Name

2. Additional Family Members Middle Name

2. Additional Family Members Last Name

2. Additional Family Members Gender

2. Additional Family Members Age

2. Additional Family Members DOB MM/DD/YYYY

2. Additional Family Members Interest

3. Additional Family Members First Name

3. Additional Family Members Middle Name

3. Additional Family Members Last Name

3. Additional Family Members Gender

3. Additional Family Members Age

3. Additional Family Members DOB MM/DD/YYYY

3. Additional Family Members Interest

Sleeping Arrangements

If shared, with whom?

Smoker In Host Family?

Return Compass USA Host Family?

Family Interests Sports Hobbies Activities

Family Pets

Dogs

Cat

Reptile

Other

Host Family Name

Please write a short welcome note below to your student and let them know why you are interested in hosting.

If possible, attach a picture of your family.

Upload File

Host Family Name

1. If you own firearms, are you willing to keep them locked up during the students stay? If not applicable, please indicate N/A in the yes/no boxes

2. Are there or have there in the past 2 years, been any drug and/or alcohol problems in the home?(If Yes, please explain)

3. In the last 5 years have you or anyone in the home been convicted of Driving under the Influence (DUI) or Driving While Intoxicated (DWI)?(If yes, please explain)

4. Have you or anyone in your home ever been accused of or convicted of child abuse, domestic violence or a felony? (If yes, please explain)

5. If you use marijuana, do you agree to refrain from use in front of your student and confirm that your student will not have access to marijuana in your home? If not applicable, please indicate N/A

6. Please describe the sleeping quarters for the student: own private room Please confirm that s/he will have his/her own bed. Please confirm that the room your student will be sleeping in has a window. If s/he is not sleeping in a standard bedroom, please explain. N/A

7. Is anyone home during the day? Please explain:

8. Does your family have any medical conditions, such as allergies, dietary requirements or disabilities that might impact a visitor in your home? If yes, please explain:

9. Will there be a phone available in your home at all times in case your student needs to make an emergency phone call? Is there an available internet/ WiFi in your home? 24/7 phone availability is available? If no, please explain: N/A

10. Is any language besides English regularly spoken in the home? If yes, will only English be spoken while the student is in the home?

11. We give Compass USA consent to share our photo(s) and/or quote(s) on Compass USA social media including but not limited to the website(s), Facebook, Pinterest and Instagram

New Field

Please note a general background check will be done on all members of the family 18 years of age and over. In addition, your coordinator is required to make a personal visit to your home. My Home Visit is Scheduled for (date): By checking the box to the right, the host family certifies the above information is true and correct to the best of your knowledge and agrees to host a student for Compass USA from to Compass USA offers a weekly stipend to our host families as a small thank you to help cover incidentals while your student is with your family. Alternatively, you may choose to donate all or a portion of your stipend to the scholarship program. Please indicate your preference on the stipend request / evaluation form that your coordinator will give you at the end of the program. Please note the stipend check will be mailed 3 to 4 weeks after your student has departed.

Reference #1 - Full Name

Reference Address

Reference Phone Number

Reference Email Address

Reference #2 - Full Name

Reference Address

Reference Phone Number

Reference Email Adress

Your Name

Your Email Address

BECOME A HOST FAMILY

HOST FAMILY INTERVIEW & MATCHING FORM

+1.720.957.1634
info@compass-usa.net

Terms & Conditions - Privacy Policy - Contact Us

Powered by The Content Agency

BECOME A HOST FAMILY

HOST FAMILY INTERVIEW & MATCHING FORM

+1.720.957.1634 info@compass-usa.net

Terms & Conditions - Privacy Policy - Contact Us

Powered by The Content Agency

+1.720.957.1634
info@compass-usa.net