Chaperone Host Family Questionnaire Question Title 1. Your name First name Last name Question Title 2. Street address Question Title 3. City Question Title 4. State Question Title 5. Zip Code Question Title 6. Email address Question Title 7. Best phone number to contact you Question Title 8. Which country would you prefer to host a Chaperone from? Latvia Ukraine Either Question Title 9. Would you prefer Male, Female or Either? Male Female Either Question Title 10. Which age range would work best for your family? (select all that apply) 25-35 35-45 45-55 Question Title 11. What is your work schedule? Full-time Part-time Other (please specify) Question Title 12. How many hours a week will at least one spouse be home? Question Title 13. Are you willing to drive your chaperone to meet host families for day outings if necessary? (You would not be required to stay for the day - just drive to a meeting place.) Yes No Comments Question Title 14. What are your interests and/or hobbies? Question Title 15. How many children do you have in your home? Question Title 16. Are any foreign languages spoken in your home? Yes No If yes, please specify which languages Question Title 17. Have you hosted a child, chaperone or exchange student in the past? Yes No If yes, please specify Question Title 18. Do you have good cell phone/internet coverage in your home? Yes No Question Title 19. Additional Comments Question Title 20. May we share your email address with the chaperon you are hosting? Some like to contact you ahead of hosting via email. Yes No Please email a picture of the outside of your home and of your family to khannon@nhfc.org. These do not need to be anything special - just some quick pictures to help our chaperons get an idea of where and with whom they are staying. This helps so much with their nervousness - especially when it is their first trip to America. Thank you! Done
