Mishima Program 2019 Homestay Host Application

1. Introduction and Application

Texas International Education Consortium (TIEC) thanks you for considering hosting an international student! This application will provide TIEC with information that will be used to consider your household as a host for a Japanese student who is participating in the Mishima Program and seeking a weekend homestay in the Greater Austin Area.

This application has 4 pages- be sure to complete all pages and digitally sign at the end!

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 over age 18. 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.

Roles and Responsibilities
Host:
Hosts agree to the following expectations:
* Picking up student(s) at TIEC, 1103 W. 24th Street, Friday, August 2nd, between 5-6pm, and drop off at Dobie dormitory, 2021 Guadalupe St., Sunday, August 4th, in the afternoon or evening before 8pm.
* Providing all meals and lodging during this time period.
* Ensuring a safe environment during the host stay, to include handling any illnesses, medical needs, or emergencies, and notifying TIEC immediately should any of these occur.
* Exposing students to American culture; including students in family traditions, activities, and home life.

TIEC:
*Schedule a brief home visit.
*Confirm placement of students in your home.
*Provide the homestay host with a stipend of $100 per student upon completion of the homestay and submission of required evaluation forms. The stipend is meant to help defray the costs of meals and activities.
*Issue an IRS Form 1099-Misc. to any homestay host for cumulative payments of $600 for hservice rendered to TIEC during one calendar year. Payments reported on IRS Form 1099-Misc. are listed as Non-Employee Compensation and are subject to Federal and self-employment tax. Please confer with your tax consultant for proper reporting to tax authorities.

Question Title

* Contact information for Head of Household

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Email Address

Phone Number

Question Title

* How long have you lived at this address?

Question Title

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

Question Title

* Cell Phone

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