Hosting Application

Host Family Information
Oregon Host Student Name*
First Last
Oregon Host Student Age*
Grade in 2019-2020 School Year*
High School*
Hosting Family Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Hosting Family Phone*
Primary Email*
Secondary Email
Hosting Requests
Preferred Session*
Do you have flexibility to do either session if needed?*
Male or Female*
How did you learn about our program?
- Classroom presentation
- Internet Search/Website
- Teacher
- Informational Session
- Friend/Classmate
- Family Member
- Video
- Signs, Posters, Flyers at my school
- Other
Spanish Teacher's Name
Spanish Teacher's Email Address
Parent Information
Fathers Name
First Last
Fathers Occupation
Fathers Address (If different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fathers Cell Phone
Fathers Employer
Fathers Schedule (Hours/Days)
Fathers Birth Date
Date Format: MM slash DD slash YYYY
Mothers Name
First Last
Mothers Occupation
Mothers Address (If different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mothers Cell Phone
Mothers Employer
Mothers Schedule
Mothers Birth Date
Date Format: MM slash DD slash YYYY
I acknowledge/approve a criminal background check will be run on any adult 18+ living in the household*
- Yes
- No
I acknowledge/approve that confidential references may be contacted to determine suitability of the hosting situation.*
- Yes
- No
Household Members Information
Listing of all parents, brothers, sisters, relatives or others living in the household.
Member Name
Relationship
Birth Date
Age
Member Name
Relationship
Birth Date
Age
Member Name
Relationship
Birth Date
Age
Member Name
Relationship
Birth Date
Age
Member Name
Relationship
Birth Date
Age
Is English the primary language spoken at home*
- Yes
- No
If NO, what language(s) are spoken
What pets do you have
Pet(s) Stay
- Indoors
- Outdoors
- Both
How frequently do you participate in church activities
Church Activities - Monthly
Church Activities - Weekly
If you attend church, would your host student be expected to attend with you
- Yes
- No
- Optional
Affiliation
Would there be a problem hosting a student of a different race/religion
- Yes
- No
If YES, please explain
Household Information
Will the student share a room*
- Yes
- No
If YES, with whom
(The student must have their own bed but it is perfectly acceptable to share a room with a family member of the same gender.)
Has your family previously hosted an exchange student
- Yes
- No
If YES, what program/country
Will you be hosting any other exchange students or Spanish-speaking visitors at this time
- Yes
- No
If YES, from where and what dates
If you know a specific student who is traveling in the group and would like to host them, identify them below.
Specific Students Name
Has anyone currently living in the household ever been arrested and/or convicted of a felony or misdemeanor?
Felony*
- Yes
- No
Misdemeanor*
- Yes
- No
If YES, please explain below
Brief Medical Information
Does any family member currently have:
A serious or chronic illness
- Yes
- No
Any disability, nervous or mental disorder
- Yes
- No
If YES, please explain below
Dietary Restriction
If you chose OTHER above, please explain below
Please upload recent photos of family members
To help with identification, please name the photos with the name of the individual. (e.g. johndoe.jpg) Please only upload a single photo. Larger images will cause issues with form submission so please keep the image file size to a minimum.
Upload Photo(s)
Drop files here or

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Oregon / Costa Rica High School Exchange Program
Host Family Application - Part II
To be completed by a parent
Host Student Name*
First Last
Please briefly describe your neighborhood and your residence*
(Include number of bedrooms, bathrooms, urban or rural, etc.)
Why are you applying to be a host family*
Describe a typical evening for your family and how your exchange student might fit into these activities and experience your community.*
Please describe your family interests/hobbies*
To the best of my ability, I am willing to help my Costa Rican exchange student improve his/her English and, in order to promote a truly positive experience, I shall ensure that he/she is included in as many of our activities as possible during the 4 weeks that we are a host family.
Electronic Signature of Host Parent(s)*
Signature Date*
Date Format: MM slash DD slash YYYY

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Oregon / Costa Rica High School Exchange Program
Host Family Application - Part III
To be completed by the host student
Host Student Name*
First Last
Birth Date
Date Format: MM slash DD slash YYYY
Email Address
Cell Phone
Are you in regular attendance at school
- Yes
- No
Approximate days absent last year
Do you have a part-time job*
- Yes
- No
How many hours per week will you be working during the month you'll be hosting
What jobs do you have at home*
What do you do in your spare time*
(Please list favorite hobbies and pastimes)
What school/community/church clubs are you involved in*
What kind of music do you like?*
Do you play a musical instrument? If so, which one(s)*
What are your favorite school subjects*
Do you play any winter sports? What and How many hours per week*
Do you like to read? If so, what kinds of books or magazines*
What is types of TV shows/movies do you like to watch?*
Please add 3 to 5 words or phrases that best describe you*
Based on your extra curricular activities (sports, job etc.), Do you feel you have enough time to devote to making your Costa Rican brother/sister welcome and part of your daily life?
To the best of my ability, I am willing to help my Costa Rican brother/sister improve his/her English and, in order to promote a true friendship, I shall include him/her in as many activities as possible during the 4 weeks that I am the host student.
Electronic Signature of Host Student*
Signature Date*
Date Format: MM slash DD slash YYYY
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Step 1 of 3

Host Family Information

Hosting Requests

Parent Information

Household Members Information

How frequently do you participate in church activities

Household Information

If you know a specific student who is traveling in the group and would like to host them, identify them below.

Has anyone currently living in the household ever been arrested and/or convicted of a felony or misdemeanor?

Brief Medical Information

Please upload recent photos of family members

Oregon / Costa Rica High School Exchange Program

To be completed by a parent

Oregon / Costa Rica High School Exchange Program

To be completed by the host student

Based on your extra curricular activities (sports, job etc.), Do you feel you have enough time to devote to making your Costa Rican brother/sister welcome and part of your daily life?