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Homestay Application Form

Please complete your homestay application below. A Homestay Coordinator will contact you after we receive your application. If you have questions you can email info@myinternationalfamily.com or call us at +1 (312) 674-7117.

First Name *required

Last Name *required

Email *required

Phone *required

I am the: *required

Will the Client attend school during their stay? *required

Yes

Agent's Information

The Agent will serve as the Client’s Primary Emergency Contact unless a secondary person is specified below.

First/Last Name *required

Company/Organization *required

Mailing Address *required

Email *required

Phone *required

WeChat

How did you hear about us?

Emergency Contact

The Parent will serve as the Client’s Secondary Emergency Contact if none listed here.

First/Last Name

Home Address

Relationship to Client

Phone

WeChat

Parent Information

Parent will serve as secondary Emergency Contact unless alternate is completed above.

Mother's Name

Phone

WeChat

Father's Name

Phone

WeChat

Home Address

Client Information

First Name *required

Last Name *required

American Nickname

Home Phone *required

Cell Phone

Email *required

WeChat

Home Address

City/Province

Post Code/Country

Does the Client smoke? *required

Yes - Cigarettes

Yes - Hookah / Cigar

No - I (the Client) do not smoke

Date of Birth (month/day/year)

Age (at arrival)

Gender

Male

Female

Nationality

Native Language

Religion (optional)

Visa Type

F-1

J-1

Other

Other Visa Type

Occupation

High School Student

College/University Student

Other

Other Occupation

English Language Level

Beginner

Intermediate

Advanced

* Only Clients of legal age are permitted to purchase, possess or use tobacco products. Underage Clients currently smoking must quit prior to enrollment in any MIF program.

Medical Conditions and Allergies

Does the Client have any pet, food or environmental allergies?

Yes

If YES, please specify:

Has the Client ever been hospitalized?

Yes

If YES, please specify:

Has the Client ever been diagnosed with a physical illness, condition or disease?

Yes

If YES, please specify:

Has the Client ever been diagnosed with a mental illness, condition or disease?

Yes

If YES, please specify:

Is the Client taking any prescription drugs or medications?

Yes

If YES, please specify:

Has the Client recently, or is he/she currently undergoing medical or mental illness treatment or counseling?

Yes

If YES, please specify:

Additional Information

Has the Client attended school or lived in the US before?

Yes

List previously attended US schools/universities/internships/work:

Has the Client lived with a host family before?

Yes

If yes, where and for how long?

List previously visited US cities:

Hobbies, interests or extra-curricular activities:

Write a message to the Host Family here or attach the Client’s Personal Statement:

How did you hear about us?

Daily/School Transportation Information

*additional fees may apply

Select all that apply:

Client will take the school bus (if available)

Client requests Host Family to drive to/from school

Client will take public transportation

Client has a car

Client wishes to hire a daily car service

Other

Other:

For Students currently enrolled in sports or extracurricular activities, describe any transportation which would require regularly scheduled driving by the Host Family. Include location and frequency of Student’s participation, and day(s) and time(s) of drop off and pick-up.

Client's siblings (if any)

Sibling Name/Age/Gender

K-12 Student Concierge Service (applicable for K-12 semester or academic year students only):

Returning Student (same school only) - $500.00

New Student - $750.00

Please select one option:

Yes, I wish to add this to the Student's Homestay Contract.

No, I choose to waive this dedicated assistance for the Student.

K-12 Student Concierge Service includes*:

Two (2) Airport Transfers: initial arrival and final departure
School Orientation attendance and transportation
School Shopping: assistance with shopping for uniforms, shoes, school books and school supplies
Assistance with cell phone service set-up
Coordinating with the school faculty for completion of post-acceptance school forms required on Student’s arrival such as: bussing, lunch forms, emergency contact form, medical information card, etc. (Does not include application or I-20 paperwork).
Medical Appointments: scheduling and transportation for school required medical physical, dental check, any missing immunizations
Homestay Coordinator support with booking non-contracted services such as: emergency travel arrangements, tutoring services, transportation arrangements requested outside of contracted services

*Additional fees apply for tolls, non-local airport transfers (over 15 mi distance from Homestay), New York airports and students booking Unaccompanied Minor Service Package with the airlines. Additional airport transfers may be booked separately. Students must pay for all personal purchases/expenses, medical costs and cell phone plan. Host families are not permitted to pay for Student purchases or loan the Student money. Fees for non-contracted services will be quoted at time of request.

Homestay Information

MIF cannot and shall not accommodate discrimination or Client requests based on Host Family: Race or Color, National Origin, Religion, Sex, Familial Status, Handicap, or Disability. As such, requests for Host Families that violate these laws will not be honored. All state and local laws prohibiting discrimination will apply.

Select Program:

Homestay Only

Add Tutoring (additional fees apply)

Add Cultural Excursions (additional fees apply)

Length of Stay:

Homestay Start Date (month/day/year):

Homestay End Date (month/day/year):

I prefer a:

Private Room

Shared Room (with other guest)

Share with my friend:

Friend's Name:

Meal Preferences

Meals

With meals

Without meals

Requested Meal Type

Pork free

Beef free

Dairy free

Vegetarian diet

Vegan diet

Kosher diet

Client preferences

Preferences are taken into consideration, but cannot be guaranteed. Clients should expect to share a Host Family with other international guests.

I prefer a home:

With Host Children (0 to 17 years old)

Without Host Children

No preference

I prefer a home:

With pets

Without pets

No preference

I prefer a home:

With other guests

Without other guests

No preference

School Information

MIF will supply the Client with a Host Family based on the information provided in the Client’s Homestay Application. MIF is not responsible for undisclosed school requirements.

School Name

School Address

Contact Information for
Student Coordinator at School

Name

Title/Position

Telephone

Entering Grade

School Orientation Date(s)

First Day of School

Last Day of School

Class Start Time

Class End Time

List any special requirements the school has of the Host Family?

Any other important school notes?

Check all boxes that apply during the Student's stay:

Student wishes to participate in afterschool sports or activities

Yes (transportation costs may apply)

Student will travel during school holiday or break

Yes (airport transfer costs may apply)

Student’s relatives plan to visit the Student during the year

Yes

No parents, relatives or visitors may stay in the homestay. Contact MIF for local hotel recommendations for visiting relatives or friends.

Destination Information

Destination City

Purpose of Travel (e.g. business, leisure, internship, etc.)

Area(s) of Interest

Planned Activities

Arrival Information

Arrival method (select one)

Client will arrive to local airport alone

Client will arrive to local airport with a parent/relative

Client will arrive to Host’s home by car with a parent/relative

Method of arrival unknown at this time

Other:

Airport Transfers (flight itineraries must be submitted to MIF 21 days in advance of all requested airport transfers)

*additional fees may apply

Client requests airport pick up on arrival?

Yes

No (If no, specify arrival method above)

Client requests airport drop off at departure?

Yes

Has the Client booked an Unaccompanied Minor Package with the airline?

Yes

*Client’s Agent or Parent must notify MIF in advance (concurrently with flight itinerary) if booking an Unaccompanied Minor Package with the airlines. Airport transfer(s) provided by the Host Family incur an additional per transfer fee of $100 when an Unaccompanied Minor Package is booked. Additionally, fee(s) will be collected retroactivity if MIF is not notified in advance.

Homestay Application Form

Please complete your homestay application below. A Homestay Coordinator will contact you after we receive your application. If you have questions you can email info@myinternationalfamily.com or call us at +1 (312) 674-7117.

Agent's Information

Emergency Contact

Parent Information

Client Information

Medical Conditions and Allergies

Additional Information

Daily/School Transportation Information

Client's siblings (if any)

K-12 Student Concierge Service (applicable for K-12 semester or academic year students only):

Homestay Information

Meal Preferences

Client preferences

School Information

Contact Information for Student Coordinator at School

Check all boxes that apply during the Student's stay:

Destination Information

Arrival Information

Airport Transfers (flight itineraries must be submitted to MIF 21 days in advance of all requested airport transfers)

Contact Information for
Student Coordinator at School