📝 Host Family Application

Thank you for your interest in becoming a host family at POLY Languages Institute. Your support in offering a safe, welcoming, and culturally rich home environment plays a vital role in the success of our international students.

To begin the screening process, please complete the application form below. Your responses help us make appropriate and thoughtful student-family matches.

📸 Photo Upload Guidelines

To ensure transparency and help students feel comfortable with their future living arrangements, we ask that you include clear, recent photos of the following:

• Exterior of your home
• Common living areas (e.g., living room, kitchen, dining area)
• Each student bedroom and its corresponding bathroom

✅ Optional: You are welcome to upload photos of household members and any additional areas that may enhance a student’s stay. This could include:

• Study/workspace
• Backyard or patio
• Fitness or recreational areas
• Any other special home features you’d like to highlight

These visuals help students feel more confident and connected before arrival. Thank you for your cooperation and care in completing the application.

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Contact Information

Name *

First

Last

Email *

Phone *

How did you hear about our Host Family Program? *— Select One —BingGoogleInstagramFacebookYahooYelpFormer hosted studentOther

Please specify. *

Household Information

Please provide the following details for all household members living in the host family’s house. In the Relationship column, indicate the relationship of each member to the primary contact person/host family.

How many household members? *— Select One —12345+

1. Full Name *

2. Full Name *

3. Full Name *

4. Full Name *

1. Sex *— Select One —MaleFemale

2. Sex *— Select One —MaleFemale

3. Sex *— Select One —MaleFemale

4. Sex *— Select One —MaleFemale

1. Age *

2. Age *

3. Age *

4. Age *

1. Relationship *

2. Relationship *

3. Relationship *

4. Relationship *

All other members. *

If you have five or more household members, please list them, stating the name, sex, age, and relationship of each member.

Are there any pets in the household? *

• Yes
• No

If yes, please specify. *

Languages Spoken in Your Household

Primary Language Spoken *— Select One —EnglishSpanishArabicChineseFrenchJapaneseKoreanPortugueseTagalogVietnameseOther

Secondary Language Spoken— Select One —EnglishSpanishArabicChineseFrenchJapaneseKoreanPortugueseTagalogVietnameseOther

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Housing Details

Address *

Address Line 1

City

AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Housing Type *— Select One —ApartmentDuplexCondominiumSingle-family homeTriplexQuadplexOther

If Other, specify. *

No of Bedrooms *

No of Bathrooms *

House Exterior *

Click or drag files to this area to upload. You can upload up to 3 files.

Please provide pictures of the house. If you reside in an apartment or condo, kindly include pictures of the building and the entrance lobby, if applicable.

Common Living Area *

Click or drag files to this area to upload. You can upload up to 3 files.

Household Members

Click or drag files to this area to upload. You can upload up to 3 files.

Additional (Optional)

Click or drag files to this area to upload. You can upload up to 3 files.

If there are any additional photos you would like to share with students, please feel free to upload them here.

Meal Provision *— Select One —Breakfast OnlyDinner OnlyBreakfast and DinnerNone (Student must cook their own meals.))

How many bedrooms are available for students? *— Select One —123

You may upload up to two pictures for each bedroom and bathroom.

1. Bedroom *

Click or drag files to this area to upload. You can upload up to 2 files.

1. Bathroom *

Click or drag files to this area to upload. You can upload up to 2 files.

1. Bathroom Accessibility *— Select One —PrivateShared with MenShared with WomenShared with Men and Women

1. Monthly Rent *

2. Bedroom *

Click or drag files to this area to upload. You can upload up to 2 files.

2. Bathroom *

Click or drag files to this area to upload. You can upload up to 2 files.

2. Bathroom Accessibility *— Select One —PrivateShared with MenShared with WomenShared with Men and Women

2. Monthly Rent *

3. Bedroom *

Click or drag files to this area to upload. You can upload up to 2 files.

3. Bathroom *

Click or drag files to this area to upload. You can upload up to 2 files.

3. Bathroom Accessibility *— Select One —PrivateShared with MenShared with WomenShared with Men and Women

3. Monthly Rent *

Host Family Requirements *

Visual Code

Please list any preferences, expectations, or house rules (e.g., curfews, kitchen use, quiet hours). If none, please write “None.”

Acknowledgement *

• By submitting this application, I confirm that all the information provided is true and accurate to the best of my knowledge. I understand that completion of this form does not guarantee my selection as a host family. Furthermore, I acknowledge and agree that the information provided in this application, including accompanying photos, may be shared with prospective students who have applied for accommodation. I consent to a home visit as part of the selection process. These acknowledgements are made to ensure the integrity of the application process, facilitate the best match between host families and students, and prioritize the privacy and security of all parties involved.

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