HOST FAMILY APPLICATION FORM

Form A. Host Family Composition

(***Внимание: ПРОСЬБА ОТВЕТЫ В ЭТОЙ ФОРМЕ ЗАПОЛНЯТЬ

НА АНГЛИЙСКОМ ЯЗЫКЕ***)

1. Programtype:

 year semester trimester 1-3 week

2. Preferences to host

 A boy  a girl  doesn’t matter

3. Our family would like to host a student from (indicate a country):

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4. Home address (mailing address as required for post delivery):......

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5. If you live in a small town, write which is the closest larger community:

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6. Home phone: ......

7. The host family member living at home:

First, last name / Date of birth / occupation / relationship / Mobile phone / e-mail

8. Familymemberslivingseparately.

First, last name / Date of birth / occupation / relationship / Mobile phone / e-mail

9. Has your family ever participated in AFS program before?:

 no yes:

as host family

 family member has been an AFS participant (where and when)

10. The participant will:

have a room of his own share a bedroom with………………………….

11. Your religious affiliation, if any and if yes, how often do you attend religious services.

 regularly occasionally  never

12. Please comment about hosting a participant who has a different or no religious affiliation:

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13. Would your family be willing to host a vegetarian or someone with dietary restrictions?

 yes  prefer not  strongly object

14. Does your family have dietary restrictions, including for medical, religious, or self-imposed reasons?

 yes  no

If yes, please explain……………………………………………………………………………………..

15. Are alcoholic beverages consumed in the home?

 yes  no

If yes, describe any rules you have on consumption of alcohol. ……………………………………………………………………………………..

16. Does anyone in your family smoke?

 yes  no

If yes,inside the house? yes  no

17. What are your feelings about a participant who smokes?

No problem Prefer not OK if outside of home Strongly object

18. Do you have any pets? If yes, please list the kind of pets and the amount of time spent indoors

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19. What language is spoken at home?

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20. What other languages are known by family members?

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21. How did your family become interested in hosting?

School Ads MailingAFS ChapterAFS Unaffiliated Chapter Previous Hosting Other

FORM B. School, Community, and Host Family Interests

(***Внимание: ПРОСЬБА ОТВЕТЫ В ЭТОЙ ФОРМЕ ЗАПОЛНЯТЬ

НААНГЛИЙСКОМЯЗЫКЕ***)

1. Name of the school host family would like the participant to attend

(Write the name of the school)………………………………………………………………………………………………………….

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2. Distance from home to school………………………………………………………………………

3. Transportation method to school?

 on foot …………………………………………………

 by urban transport …………………………………….

 by personal transport

4. Name and year in school of any children in the family who will be attending the same school as the AFS participant next year

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5. Type of Community

 Urban Suburban

Small Town Rural

Other…………………………………………………………………………………………..

6. Population of your Community ……………………………………………….....

7. Name of Closest Large City………………………………………………………………………

8. Distance …………………………………………………………………………………………….

9. Population ……………………………………………………………………………………………

10. Describe the local recreational and cultural facilities available (pool, theater, sport, etc):

Stadium/sports ground sport school

Art school cinema

Computer club swimming pool

Music school

Other......

11. Describe your community, including social and economic charcteriatics, ethnic makeup, availability of public transportation, etc.

List any websites the participant could visit to learn more information about your community.

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12. Describe the climate in your community.

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13. Host Family Interests.

Please indicate what are the major interests, hobbies and activities of members of your family.

Individual Sports

 AerobicsFishingRunningBicycling

 HikingYoga Horseback RidingCamping/Backpacking

 HuntingSkateboarding

Winter Sport

 Ice Skating  Ice Hockey SnowboardingCross-Country Skiing

Downhill Skiing

Organized Sport

 Football (soccer)SwimmingBasketballVolleyball

 Tennis GymnasticsField Hockey

Community Activities

School ActivitiesVolunteer Activities

Art, Dance & Theater

Attending Theater Photography/Video BalletCinema/Movies

Drama/Theater Drawing/Painting Art Handicrafts

DanceMuseums/Exhibitions

Music

 Attending ConcertsListening to Music String InstrumentsOrchestra/Band

 Wind/ Brass Instruments Drums/Percussion  Playing Piano Playing Guitar

Singing/Chorus

Individual/Family

 Cooking/BakingComputer GamesGardening Travel

 Board Games/CardsIndoors-oriented Outdoors-oriented  Watching

 ShoppingInternet Collecting  Television

Reading Chess  Family and Friends visits

Form C. Host Family Description

(***Внимание: ПРОСЬБА ОТВЕТЫ В ЭТОЙ ФОРМЕ ЗАПОЛНЯТЬ

НААНГЛИЙСКОМЯЗЫКЕ***)

1. Describe each member in the family (including yourself) as to personality, interests, etc.

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2. Describe a typical weekday and weekend in your family Be sure to mention any common family activities and interests.

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3. Describe what is important in your family. What are your family values?

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4. What kinds of chores do you expect family members to help with around the house?

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5. What kinds of rules do you have in your household? (Such as curfews, limits on computer, TV, or telephone use, etc.

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6. Why is your family interested in hosting an AFS participant?

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7. The AFS participant you host may come from a family and culture with different habits and expectations about meals.

Are there meals the AFS participant would be expected to get for him/herself? If the participant will take a lunch to school who will prepare the lunch? Do you eat meals together as a family? What responsibilities will the AFS participant and host siblings have in meal preparation and clean-up?………………………………………………………………………………………………………………………………………………………………………………………………………………………

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8. Please give a physical description of your home and the AFS participant's bedroom.

Also indicate whether the participant will have easy access to musical instruments, computers and a quiet place for study ……………………….……………………………………………………………..

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9. If a host parent is divorced or separated and shares custody of the host sibling(s), please indicate how often the host sibling(s) will be in their other parent's household.

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10. If anyone in the home has a serious illness or chronic medical condition, please give a brief description.

 yes  no

If yes, please explain……………………………………………………………………………………..

11. If there have been any other recent changes in your family circumstances, please describe.

 yes  no

If yes, please explain……………………………………………………………………………………..

12. Participant’s name ( if known)

13. Country ………………………………………………………………………………….

Спасибо!

Contactinfo:Intercultura Foundation 109004 Moscow, A.Solzhenitsyna str, 27l: +7 (495) 987 3275

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