Name:

Cover
FAMILY PHOTO

In the photo (left to right):

FAMILY MEMBER
Name Family Member Date of Birth

LOCATION

Address: Home city:

Home state / province: Home country: Italy

Home Phone: AFS sending organization: ITA

FORM OFFICE USE ONLY

Service ref: Program applying for:

OA status: Prefer Country:

Local Chapter: Area Team:
Region: Program Duration Pref:
 Name:

FORM A. Host Family Contact, Composition & Placement

HOST FAMILY CONTACT
Family of:
Parent:

Title First name Middle name/intial Last name

Business Phone Mobile Phone Fax

Occupation Employer Email

Parent:

Title First name Middle name/intial Last name

Business and/or Mobile Phone Mobile Phone Fax

Occupation Employer Email

Home Address

Address

Home City Home ZIP/Postal Code Home State/Province

Italy
Home Email Home Phone Home Country

HOST FAMILY COMPOSITION

Title First name Middle name Last name Relationship Living at home Year of Birth Country of Birth

PLACEMENT INFORMATION
We are applying to host for a Year Semester Trimester Short-term Preferred Arrival Month
Our family would like to host a Male Female Either Year
Our family would like to host a student from
Participant must have a bed of his/her own. Will the participant share a bedroom? Yes No
If yes, with whom?
Never
What is your religious affiliation or preference, if any?
How often do you participate in religious services or activities? Weekly Monthly Occasionally
Please comment on hosting someone with a different or no religious affiliation.
Would your family be willing to host a vegetarian or someone with dietary restrictions?
Yes Prefer not Strongly object
Does your family have dietary restrictions, including for medical, religious, or self-imposed reasons? Yes No
If yes, please explain
Are alcoholic beverages consumed in the home? Yes No
If yes, describe any rules you have on consumption of alcohol.
Does anyone in your family smoke? Yes No Inside the house? Yes No
What are your feelings about a participant who smokes?
No problem Prefer not OK if outside of home Strongly object
Do you have any pets? Yes indoors Yes outdoors No
If yes, please list the kind of pets and the amount of time spent indoors.
What language is spoken in the home?

What other languages are known by family members?

Have you ever hosted with AFS or another organization?
No Yes with AFS Yes with another organisation
Which organization?
Which year(s)? Country(ies)?

Is a member of your family an AFS returnee? Yes No Which year(s)?

Name Country(ies)?
How did your family become interested in hosting?
School Ads Mailing AFS Chapter Previous Hosting AFS Other
 Name:

FORM B. School, Community, and Host Family Interests

SCHOOL
Name of the school host family would like the participant to attend
Distance from home to school
Transportation mathod to school
Name and year in school of any childen in the family who will be attending the same school as the AFS participant next year

COMMUNITY
Type of Community Urban Suburban Small Town Rural Other
Population of your Community
Name of Closest Large City Distance Population
Describe the local recreational and cultural facilities available (pool, theater, sport, etc)

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.

Describe the climate in your community.

HOST FAMILY INTERESTS

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

FORM C. Host Family Description Form

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

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

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

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

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

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

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?
HOME ENVIRONMENT
1. 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.

2. 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.

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

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

Photo Page

PHOTO
To help you introduce yourself and your family, assemble a small collection of photographs showing how your family lives and what is important to
you and your family members.
Please upload the photos and type a short phrase to describe each photo. Be creative!