KAEC 2020 Homestay Host Application

The purpose of this application is to provide the Texas International Education Consortium (TIEC) with information that will be used to consider your household as a possible match with an international student or exchange visitor (guest) who is participating in a TIEC program and seeking a homestay.

TIEC will preserve the confidentiality of all information provided. This information is for use by TIEC only.

It is the policy of TIEC to conduct thorough background checks on residents of the household. Individuals, who are found to have a criminal history relating to children or family violence, including child or spousal abuse, neglect, and sex offenses, are not eligible to participate in this program.

Please fill in the requested information, then digitally sign and date the form.

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* Contact information for Head of Household

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

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* In what type of building do you live?

Single-family dwelling

Condo/Apartment

Other (please specify)

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* Do you own your residence?

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* How long have you lived at this address?

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* If less than two years, list previous addresses during that period

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* Occupation and current employer

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* How long have you worked for your current employer?

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* If you have worked for your current employer for less than seven years, list previous employers during this period:

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* Work Phone

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* Marital Status:

Single

Married

Divorced

Widowed

Other (please specify)

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* Contact information for Head of Household

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* In what type of building do you live?

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* Do you own your residence?

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* How long have you lived at this address?

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* If less than two years, list previous addresses during that period

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* Occupation and current employer

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* How long have you worked for your current employer?

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* If you have worked for your current employer for less than seven years, list previous employers during this period:

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* Work Phone

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* Marital Status:

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* If married, for how many years?