EDGE Homestay Information – usivyedgellc.com

Full Name of Host Parent(s)

Home Address:

Email Address:

Phone Number(s):

Occupation(s):

Emergency Contact (Name & Number):

Household Members

Name

Age

Gender

Relationship to Host

Occupation/School

Type of Residence (House / Apartment / Other):

Number of Bedrooms:

Number of Bathrooms:

Student Will Have (Private Room / Shared Room, Private Bathroom / Shared Bathroom):

Internet Access Available? (Yes / No):

Is smoking allowed in the home? (Yes / No):

Preferred Gender of Student (Male / Female / No Preference):

Do you have previous experience hosting international students? (Yes / No). If yes, please describe:

Languages Spoken at Home:

Meals Provided (Breakfast / Lunch / Dinner):

Special dietary accommodations:

House Rules for Students:

Distance to local high school (miles/minutes):

How will the student get to school? (Walk / Bicycle / Public Transportation / Host Family Drive / School Bus):

Why are you interested in hosting a Chinese student?:

Any cultural experience or interests you'd like to share?:

Signature of Host Parent:

Global Partner&School：