Host an International Student in California

In which group would you like to host an Exchange Student?*

April 1 to 29 ( Thailand students)

June 27 to July 18. ( European Students)

July 18 to August 8. ( European Students)

OTHERS.. or I dont know.

How many students will you host in this group?

One

Two

Three

Four

Host Parent 1: Name*

First Last

Phone 1*

Email 1*

Occupation

Year of Birth

Host Parent 2: Name

First Last

Phone 2

Email 2

Occupation

Year of Birth

Address

Street Address Address Line 2 City State ZIP Code

Everyone living in home: ( Name, Age, Gender):

Would you like to receive a small stipend to help offset some of the costs incurred while hosting?

Yes, I would like to receive a small stipend.

No, Please donate my stipend to support financial assistance to a future American Student who wishes to travel abroad.

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)?

Yes

Please explain:

Reference 1 Name

First Last

Phone Reference 1

Email Reference 1

Reference 2 Name

First Last

Phone Reference 2

Email Reference 2

Attach picture(s) of your family 1 to 4 images max:

Drop files here or

Accepted file types: jpg, jpeg, png, Max. file size: 100 MB, Max. files: 4.

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