Form Submission

Host Family Application Form

Fields with * are required

APPLICANT

SPOUSE / ROOMMATE / SIGNIFICANT OTHER
Not Applicable

*Last Name:

Last Name:

*Middle Name:

Middle Name:

*First Name:

First Name:

*Address:

Address:

*City:

City:

*Zip Code:

Zip Code:

*Primary phone#:

Primary phone#:

Secondary phone#:

*E-Mail:

E-Mail:

*Date of Birth:

Date of Birth:

*Occupation:

Occupation:

Name of company:

Work phone:

*Current relationship status:

Single

Married

Living with significant other

Relationship to applicant:

Spouse

Roommate

Significant other

*How long have you lived in Washington state?
*Distance in miles to Bremerton Campus, Olympic College
*Distance to nearest bus line
*Type of home:

Detached house	Mobile home
Duplex/triplex	Other
Condominium

*Number of bedrooms
*Number of bathrooms
Children (list names, birthrates, and sex of all children living at home with you :

*Do you have children NOT living at home?

Yes

If yes, include names and locations, city and state:

*Are any other people living in the home, including extended family members, roommates, friends or boarders?

Yes

If yes, please list names, birth dates, sex, relationship, and length of time residing in Washington State.

*Have any household members ever been convicted of a crime?

Yes

If yes, please give details:

*Do any household members have a child protective services (CPS) history?

Yes

If yes, please give details:

*Have you ever had an adoptive home study or applied for licensing?
*Do any household members have a chronic physical or mental illness?

Yes

If yes, please give details:

*Primary language spoken at your home:
Other languages spoken:
Please list pets living at the home and distinguish if they are inside or outside pets:

*Do any household members smoke?

Yes, inside

Yes, outside

*Is alcohol consumed in the home:

Never

Rarely

Occasionally

Daily

If you've hosted a student before, please list their nationality and how long you hosted:
*Bathrooms for students:

Shared

Private

*Is there a phone in the student’s room?

Yes

* If no, may the student put in their own phone line at their expense?

Yes

Please list any musical instruments in your home:

*Student preference:

Male

Female

Either

Country preference:
*Are you willing to host minors (students under the age of 18)?

Yes

*Would you allow a student to smoke at your home?

Yes, outside

Yes, inside

*Would you allow students to use alcohol in your home?

Yes

*What restrictions do you place on visits by your homestay student’s friends?

*What chores will the homestay student be asked to perform in your home?

To help match you with a homestay student, please rate your family on a scale of 1 to 5 on items you value and you believe apply to your household (one is low, five is high):
Quiet home:
Busy home:
Planned family meals:
Flexible dining:
Neatness:
Discipline:
Independence:
Communication with family:
Individuality:
Sharing household responsibilities:
Manners:
Family-centered activities:
Punctuality:
Humor:
Privacy:
Patience:
Affectionate:
Other:

*Some American families spend most of their free time at home while others prefer activities away from the house. Some families have regular evening commitments, while others do not. Which tends to describe your situation?

*Please list activities that your family enjoys:

Is there any other information about yourself or your family, which you wish to share?

*Why do you wish to host an international student?

*List two individuals not related to you who will serve as character references (name, address, phone, email and relationship to you required).

Housing categories

Traditional homestay (for students who want a family-like atmosphere):

$625 monthly rate
All food included; host provides five prepared dinners per week.
All utilities included.
Minimum stay expected: one quarter (12 weeks) /one summer session (4 or 8 weeks)
Host should plan to include students in their family activities.
Not included: Personal expenses, transportation, bus fare, and long distance phone calls.

Room and kitchen access (for students who want more independence)

$450 monthly rate
All utilities included.
No meals included.
Minimum stay expected: one quarter (12 weeks) /one summer session (4 or 8 weeks)
Hosts may or may not include students in family activities
Not included: Food, personal expenses, transportation, bus fare, and long distance phone calls

Traditional homestay

Room and kitchen access

Either

Additional homestay fees paid to hosts (either option)

Upon moving into your home, the student should pay you:

One time cleaning fee: $50 (non-refundable). This fee is compensation for preparing the room before and after student’s occupancy.
Security/damage deposit: $100 (refundable). This deposit is to be refunded to the student up to 30 days after leaving your home if: (a) there are no unpaid bills or damages and (b) a 20-day notice was given before moving out.

Affidavit
I certify or declare under penalty of perjury under the laws of the state of Washington that the foregoing and all information in this application is true and correct. I understand that I must answer this application truthfully and completely. Any falsification or deliberate misrepresentation, including omission of a material fact in completion of this application can be grounds for denying hosting opportunities and/or terminating inclusion in the host family program at Olympic College.

The Homestay Host Experience

Hosting an international student can be a very exciting and rewarding experience for you and for the student. This package of information is developed for host families to consider expectations of the college, the student, and to maximize the experience.

Homestay host requirements
To become involved in the homestay program at Olympic College, we require that hosts agree to the following:
•Commitment.  You must commit to host a student for a minimum of one quarter/session. The first ten days after placement is an adjustment period for the host and the student. After the ten days, both parties need to commit to a minimum of one quarter (12 weeks) or one summer session (6 or 8 weeks).

•Home environment.  Provide a clean, safe, and caring home environment with a private bedroom with bed and bedding, linens and towels, a desk and chair, study lamp, adequate storage, light and heat, a fire exit, and nearby smoke alarm. This room must be available to the student during their entire stay and cannot be made available to out-of-town visitors or guests. Hosts are expected to provide household staples such as laundry detergent and toilet paper, but not personal toiletries.

•Welcome and orientation. Welcome the student to your home and spend time to orient the student to all aspects of living there.  Because this is a new experience for most students, allow extra time for your family to get to know the newly arrived student. After the initial welcome, give them a house key, explain your house rules and expectations and teach them how to use household equipment and perform simple household chores, such as helping with the dishes, vacuuming, washing their clothes, cleaning their room or cleaning up after themselves. Provide instructions on procedures in the case of injury, fire, earthquake or other emergencies.

•Daily life. Include the homestay student in your daily life and give the student the choice of coming with you when you (a) run errands, (b) shop, (c) attend sporting events or movies, or (d) participate in family holidays. 

•English. One of the reasons to select the homestay option is to increase the opportunity to improve English language skills.  If multiple languages are spoken in the home, remember to speak English so the student will not feel “left out” of conversation.

•Meals and food. 

For "Traditional Homestay" option students, please provide a balanced variety of nutritional food for breakfast, lunch and dinner, seven days a week. The host is expected to prepare five evening meals per week, served at a time convenient for you and the student. Food should be available for the student to prepare the remainder of their meals. Please show the homestay student how to use your appliances in your kitchen and any gadgets you normally use to cook with before you allow the student to use your kitchen to prepare other meals. You should ask the student to help you prepare the grocery list. 

For "Room and Kitchen Access" option students, provide access to the kitchen for food preparation, as well as refrigerator and cabinet storage space for student-purchased food.  Please show the homestay student how to use your appliances in your kitchen and any gadgets you normally use to cook with before you allow the student to use your kitchen. 

•Transportation.  Teach your student to ride the bus if applicable and help them to become familiar with the local area and commercial establishments for shopping, groceries, and personal services.

•Telephone and Internet access. You may need to show the student how to make long distance phone calls with their calling card. Most of students have or will have their own cell phones. Others may wish to set up their own personal phone line (at their own expense) for telephone or Internet, but only if you allow this option. Internet Wi-Fi set-up is required since Internet is a part of our lives now and students need to use it at home for their studying, researching, and communicating with their families back home. Although students can access Internet and computer services at the college, they usually prefer the homestay family with Wi-Fi access.  Hosts may be asked to upgrade their Internet speed or router if there’s any ongoing Internet connection problem.

•Medical. All homestay students are required to have medical insurance, and student questions regarding coverage should be referred to International Student Services office at OC.  For emergencies, dial 911 or take them to a local emergency room.  

•Personal beliefs. The college respects all religious and philosophical beliefs. While perfectly acceptable to practice your own philosophy or religion (for example, prayers at the dinner table), please do not proselytize. The student’s belief systems should be respected. You may invite your homestay guest to join the family in religious activities, but you should not expect them to participate.

•Never ask a homestay student to baby-sit.

•Illegal substances.  Hosts must agree not to have or use any illegal substance prohibited under Federal Law in the home while a student lives there. If alcohol is consumed in your home, it is expected that the use is moderate and that you will not offer alcohol to the student.

•Changes in the homestay.
Homestay hosts agree to notify the International Student Services office of any changes in the homestay situation, including: persistent problems with a student; plans to be out-of-town for an extended period of time; changes such as family members moving in or out; pets; divorce; career changes; when the student gives notice and plans to move out; updates on address, phone and/or email, etc.

Rights of the College

The college reserves the right to remove a student from a host home at its discretion and may request a pro-rated refund of the homestay stipend. If a difference arises between the host and student, the college expects both to settle differences to the best of their abilities. A second recourse would be to contact the International Student Services office to intervene and act as a mediator, although it is understood that the college is under no obligation or liability to settle disputes. 



Compensation for Homestay Hosts

The monthly fee covers room, food (if included), utilities, cost of normal family activities and your time. The monthly fee is due to the host each month, based on the date the student moves into your home. 

Please adhere to the college guidelines regarding the monthly homestay rate, cleaning fee and damage deposit. These fees are fixed and non-negotiable. 

1. Traditional homestay $625 per month (for students who want a family-like atmosphere)
•All food included; host provides five prepared dinners per week.
•All utilities included.
•Minimum stay expected: One quarter (12 weeks) /one summer session (6 or 8 weeks). 
•Host should plan to include students in their family activities.
•Not included: Personal expenses, transportation, bus fare, and long distance phone calls.

2. Room and kitchen access $450 per month (for students who want more independence)
•All utilities included.
•No meals included.
•Minimum stay expected: One quarter (12 weeks) /one summer session (6 or 8 weeks).
•Host may or may not include students in family activities.
•Not included: Food, personal expenses, transportation, bus fare, and long distance phone calls..


*Additional homestay fees paid to hosts (either option)
Upon moving into your home, the student should pay you: 
•One time cleaning fee: $50 (non-refundable). This fee is compensation for preparing the room before and after student’s occupancy.
•Security/damage deposit: $100 (refundable). This deposit is to be refunded to the student up to 30 days after leaving your home if: (a) there are no unpaid bills or damages and (b) a 20-day notice was given before moving out.



Hosts should not depend on homestay stipends to meet their ongoing financial obligations.

Vacation Policy
A student who wishes to go out of town while living in homestay must prearrange the absence with the host family and plans must be agreeable to both parties. If the student plans to be away for 15 or more nights, the monthly stipend is reduced 50%, but only for the nights that the student is away. For absences of less than 15 nights, there is no reduction in the monthly payment.

For more information and questions on the homestay host plan, please contact International Student Programs.



 
Host Family Agreement

Olympic College
I (we) agree to be a host family in the homestay program at Olympic College according to the guidelines noted below. I will:
 
•Welcome the student to my home and orient the student to aspects of living in my home, including emergency procedure instruction in case of injury, fire, earthquake or other emergency. 

•Speak English when the student is present. (One purpose of homestay is to improve English skills through an immersion living experience.)

•Provide a clean, safe and caring home environment and a private bedroom, with: appropriate bed and bedding; linens and towels; desk, chair and study lamp; adequate storage, lighting and heat; a fire exit and nearby smoke alarm. The room will be available during the student’s entire stay and will not be made available to out-of-town visitors or guests.

•Provide a well-balanced variety of nutritional food for breakfast, lunch and dinner, seven days a week if my student selects the “Traditional Homestay” option. This will include five prepared evening meals per week served at a time convenient to me and the student, with food available for student preparation for the remainder of the meals. I will demonstrate use of kitchen appliances and give the student an opportunity to make selections for the grocery list. 

•Provide kitchen and refrigerator access for food preparation if my student selects the “Room and Kitchen Access” option, and cabinet storage space for the student’s food. I will demonstrate use of kitchen appliances.

•Work out any differences with the student to the best of my ability. If I am unable to do this, I will contact International Student Services office to request intervention and mediation, although I understand International Student Services office is not under obligation or liability to settle disputes.

•Adhere to the guidelines regarding the monthly rate, cleaning fee and damage deposit. I understand that these fees are fixed and non-negotiable and are to cover such things as room rent, food (if included), utilities, cost of normal family activities and my time. I understand that students will use their cell phone or calling card for personal phone calls, and that charges may not be made against my phone bill.

•Respect the homestay student’s religious beliefs.

•Not ask or allow the student to baby-sit children.

•Notify International Student Services office at Olympic College of any changes in the homestay situation; i.e., persistent problems, plans to be away from the home for an extended period of time, family members moving in or out, pets, divorce, career changes, updates on address, phone/e-mail address, or move-out notice received from the student.

•Agree not to have or use illegal substances prohibited under Federal Law in the home.

•Agree to use moderation when alcohol is consumed in the home.

•Agree not to host any other student concurrently with the homestay student placed by the college in my home without a prior approval. 

•Consent to a criminal background check made by any local, state or federal agency and consent to a background check on behalf of myself and all household members that are under the age of 18.  I will obtain written consent from all other adults residing in the house to consent to a criminal background check. 

•Agree to waive my right to privacy under the Washington State Privacy Act in so far as Olympic College may release my address and telephone number for the student’s business purposes only (agencies, doctors, hospitals, etc.)

•Agree to indemnify and hold harmless Olympic College and its agents, employees or officers from any and all claims, actions, suits, proceedings, costs, expenses, damages and liabilities including attorney fees arising out of, connected with, or resulting from having a student live in my home and realize that I am an independent contractor.

By clicking this box, I (we) agree that I (we) have read and understand the above agreement and agree to fulfill the requirements outlined to the best of my (our) ability. If at any time I (we) cannot fulfill the obligation, I will notify International Student Services office immediately. Further, I understand that Olympic College reserves the right to terminate this agreement if requirements are not met and if negotiations are not successful in resolving issues.

Signature:		*Date:
	* I agree that typing my full name in the text box and checking this checkbox shall serve as an equivalent to my handwritten signature.
Signature of co-applicant*:		Date:
	* I agree that typing my full name in the text box and checking this checkbox shall serve as an equivalent to my handwritten signature.