Homestay Application

If you prefer PDF form, please download. Homestay Application PDF Download

* Required Field

Applicant (First to contact regarding homestay)

Host Status *

Last Name *

First Name *

Gender *

Date of Birth *

Occupation *

Work schedule *

Applicant's Spouse

Last Name

First Name

Gender

Date of Birth

Occupation

Work schedule

Home Address

Street Address *

City *

State *

Postal/zip code *

Contact Information

Applicant's Cell Phone *

Applicant's Email *

Secondary Cell Phone *

Secondary Email *

Additional phone number (if there is one)

Children

Child 1

Last Name

First Name

Gender

Date of Birth

Lives at home?

Child 2

Last Name

First Name

Gender

Date of Birth

Lives at home?

Child 3

Last Name

First Name

Gender

Date of Birth

Lives at home?

Please provide any other adult that would be living in your home.

Adult 1

Last Name

First Name

Gender

Relationship to host

Date of Birth

Occupation

Adult 2

Last Name

First Name

Gender

Relationship to host

Date of Birth

Occupation

Pets

Pet 1

Type of pet

Name of pet

Pet is kept

Pet 2

Type of pet

Name of pet

Pet is kept

House

Housing Type *

How many private bedroom and bathroom available for student *

beds,
bath

Language spoken at home *

Anyone in your family smoke?
 Yes No

Smoking allowed outside?
 Yes No

Wireless internet available
 Yes No

House Hold Annual Income

The income data collected will be used solely for the purposes of ensuring that the basic needs of the international student can be met *

Student Hosting

Have you ever hosted a international student? If yes please tell us when and the organization. *

 Yes No
Date:

Organization:

If yes, and if you know which school please list

In the space below, please tell us about your family. How would you describe the personality of your family? Do you have any special interests that you pursue together (sports, arts, travel, etc.)
Please fill out at least 1 field *

Please list any additional comments about your family that would help us to know you better and to make a better match between you and a BHI student. Please list the type of food you like to cook, special rules or diet you might have in the house that might be different from other families. ( family dinnertime, vegetarian/ vegan, bathroom rules etc)
Please fill out at least 1 field *

Summarize why your family would like to host an international student.
Please fill out at least 1 field *

Other information

Student Preference (If any)

Were you referred by another family? Please provide full name of the person who referred you.

Media/ Photo release: Is it okay if BHI needs to use any media (photo, etc.) taken in your home (usually with student) for advertising reasons on social media?

 Yes No

Please list two references that may be contacted with regard to your suitability as a host family. References from work, school, or local community are preferred over close personal friends.

Reference 1

Name *

Relationship with host *

Phone *

Email *

Reference 2

Name *

Relationship with host *

Phone *

Email *

I hereby verify under penalty of perjury that the statements made herein are true and correct to the best of my knowledge. I furthermore authorize criminal background checks to be conducted if needed for each family member over the age of 18 in my household according to the requirements of my state of residence. I acknowledge that this application in no way guarantees the placement of a student in my home.

Privacy Policy

 I Agree *

Name of host *

Date *

Optional: Please upload any family pictures or photos of your home.

File Size: up to 2MB, File Format: jpg, png only.


Brighter Horizon International

21171 S. Western Ave. Suite 2703
Torrance, CA 90501

Toll Free Number: 888-985-2072
Office Main: 424-271-9908
Tax: 424-271-9938

Operation hours: 10:00 - 18:00 M-F