Earn up to $100 per student

per week, based on a prorate

basis ______ (Initial)

Language
Travel

EF Language Travel
8 Education St.
Cambridge, MA 02141
1-800-521-0083
lt.usa@ef.com
www.ef.com/host

Basic Information
Applicants full name: _____________________________________________

HOST FAMILY APPLICATION

N
APPLICATI O
ON
Returning LT Host Family:
Referred:
Date Submitted: __________________________
# of beds/mattresses needed (if applicable): _______
Dates Available From: _______________ To: ____________
Unavailable Dates:

_______________________

For Staff Use Only Site: ______________ Intake: _______

Address: _______________________________________________________
City: _______________________________ State: _____ Zip: ____________

Course #: ______________
bus: _______________
Recruiter name: ______________________________________

Home Phone #: (

Interviewer name: _____________________________________

Cell phone #: (

)______________

Interview date: __________________

Email address: ___________________________________________________

Type of Residence:
House
Apartment / Condominium
Is your home carpeted?
Yes
No
Do you smoke?
Yes
No
Do you have any pets?
Yes
No
If you have any pets, please give details: _____________________________
Host Family Information
Information: Please list all persons who will live in the household during the

Student #

# of students: ____

Student Name

applicant))
programs duration ( including the applicant

Full Name

Gender
er d

eRelationship
G
to Applicant

Date of Birth

Occupation

Home Information
n:
Informati o
on
n: Some of the information below is required by the law of our students country of origin and does not necessarily constitute selection criterion.
Have you hosted students before?

Yes

No

If yes, with which organization?:

Indicate how you heard about EF (eg. community event, local business, organization, email, etc- not EF personnel):
?

Were you referred to

Yes

Do you belong to any organizations?

No

If yes, by whom (not EF personnel)?

Yes

No

If yes, which organizations? :

Does anyone living in your household have a serious illness, disability, or nervous disorder?
If yes, please give details:

Yes

No

Has any member of your family/household been convicted of a misdemeanor/felony?

Yes
No
If yes, please give details:
Matching Information
I nformation:
nformation :
What is the primary language spoken in your home?
Would you allow a student/Course Leader to smoke inside your home?
Yes
No
Only outside
Would you prefer to host:
Boy
Girl
Course Leader
No preference
1 student
2 students
3 students
4 students
Would you be willing to host a student/Course Leader with special dietary needs (vegetarian, food allergies, etc)?
Yes
No
Would you allow your student/Course Leader to use your computer (if applicable)?
Yes
No
Will the student(s)/Course Leaders have his/her/their own room?
Yes
No
If no, with whom will the student(s)/Course Leaders share?

LT students can only share a room with a maximum of 2 other people. The max # of foreign students per host family is limited to 4, incl. other organizations students.

Host Family Hobbies & Interests (Please mark all that apply)
Movies
Drawing/Painting
Guitar
Watching TV
Camping/Hiking
Piano
Computers
Reading
Singing
Cooking
Listening to Music
Martial Arts
Drama/Theater
Writing
Swimming
Please describe your familys lifestyle:
Reference
Name
Phone #

Tennis
Aerobics/Dance
Biking
Horseback Riding
Other: ___________

Reference
(

Baseball
Volleyball
Soccer
Basketball
Other: ________________

Local Reference
(

Signature:
Signature ____________________________________________________________________________________

Local Reference
(

)
Date:
Date _________________

I understand that as a Host Family I must provide room and board for
student(s) and arrange transportation to and from
. I also
agree to notify my
prior to taking our student(s) away overnight. I hereby
to the best of my knowledge and belief the information given on this form is correct and complete.

White copy: Boston / AM, Yellow copy: Recruiter, Pink copy: Host Family

Host Family Application LT.3.2.236.US/CA.v2