200 Bolinas Road Suite 36,Fairfax, California firstname.lastname@example.org
**Please use this form to fill in on-line by typing in the fields.
If you have questions, please call us before completing your application - 415-509-6757
Your application should be completed digitally and printed to be sure it can be clearly and accurately read. Your completed application will be automatically be e-mailed to AHA.
Son / Daughter / Other:
Interests / Hobbies / Occupation:
What other activities/hobbies does your family enjoy?
Does anyone in the household speak another language? If so, who, and which languages?
Does your family have any pets?
If so, what kind, how many, indoors/outdoors?
Has your family ever hosted an international student?
What are your family expectations in hosting an international student?
Explain the rooming situation:
Does anyone in the household smoke?
Would you agree to hosting a student who smokes?
Does any member of the household suffer from any chronic illness? If so, please specify who, and nature of illness:
You may sign this application by typing your name(s) and using your mouse, touchpad or finger to draw your signature(s) in the boxes below:
Signature of parent #1:
Signature of parent #2:
We request that you attach a few photos using the "Add Photo" box below.