WorldOregon Youth Leadership Program Host Family Application

Build lifelong connections by opening your doors to an international visitor for a U.S. home experience. Throughout the year (and especially during the summer and fall), the International Visitor Program offers the opportunity to host a youth or adult visitor from across the world—from three nights to five weeks. Overnight hosts provide a private bedroom, breakfast, most dinners, and an up-close view of daily life in an Oregon home.

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* 1. Which programs are you interested in hosting this year?

There aren't any groups to host right now, but I would like to be added to the youth hosting email list!

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* 2. Host 1 Information (The individual who will be primarily responsible for the exchange participant)

Name:

Date of Birth:

Age:

Gender:

Address where student will stay:

Cell phone:

Email address:

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* 3. Host 2 Information: (Any individual in your household who will share primary responsibility for the exchange participant, or have secondary responsibility)

Name:

Date of Birth:

Age:

Gender:

Cell phone:

Email Address:

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* 4. Please list the name and age of all other persons living in the household during the time of the program (including children, roommates, other international exchange visitors, etc):

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* 5. Background Information

Where/how did you first hear about the exchange program?

Why do you and your family wish to participate in this exchange program as hosts?

Most youth exchange programs also include adult participants from the participating countries who travel with the students as mentors. Would you prefer to host youth participants (15-18 years old) or their adult mentors/chaperones?

Would you prefer to host male-identifying or female-identifying visitors?

Are you able to host one or two youth/adult mentors?

Please indicate any foreign language background.

Please tell us a little bit about your family. What are your interests, hobbies, regular activities? Occupations? Religious affiliations? Family dynamics or routines?

Please describe the housing available for the visitor (beds available, shared/separate bedroom/bathroom).

What kind of transportation support would you be able to provide? Visitors will begin and end each program day at WorldOregon offices (1207 SW Broadway, Portland, OR 97205). If a member of your family cannot drive the participant, they can take public transportation with an orientation to a from program activities on the first day. Carpooling with other hosts may also be an option.

Please list any pets you have in your home.

Do you have any additional comments or things you would like to share?

Please list two personal references:

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* 6. Reference # 1:

Name:

Personal phone:

Email:

Relationship to you:

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* 7. Reference # 2:

Name:

Personal phone:

Email:

Relationship to you:

Applicant Approval

By typing my name below I agree that all of the information in this application is true and I agree that if chosen to participate, I will abide by the Homestay Guidelines provided by WorldOregon. Moreover, I and any household members over the age of 18 agree to undergo a background check as is required by the program.

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* 8. Signature

Host 1 Name:

Date:

Host 2 Name:

Date: