NorthWest Student Exchange

4530 Union Bay Place NE, Suite 214

Seattle, WA 98105, USA

Phone: 206-527-0917, Fax: 800-717-9117

E-mail: , Web:

CONFIDENTIAL SECOND HOST FAMILY VISIT

To be completed, submitted and viewed only by the Second Visitor

This second visit is to be conducted only after the exchange student has moved into the home

EXCHANGE STUDENT NAME(S):
NAME OF HOST FAMILY:
HOST ADDRESS:
NAME OF SECOND VISITOR:
SECOND VISITOR TELEPHONE:
SECOND VISITOR EMAIL:

PLEASE CHECK ALL THAT APPLY FOR THE FOLLOWING ITEMS:

1) TYPE OF NEIGHBORHOODUrban/Big City Small City Suburban Country/Rural

2) APPEARANCE OF NEIGHBORHOOD

Excellent (safe, well-maintained) Good (safe, well-maintained) Average

Fair Poor (not safe or not well-maintained) If “Poor,” please describe:

3) TYPE OF HOME Single Family Town Home Apartment Condo Other

4) External Appearance of Home and Grounds (cleanliness, general upkeep):

Excellent Good Average Fair Poor (If “Poor,” please describe: )

5) HOST FAMILY HOME (including kitchen, living room, bathroom and other spaces used for living)

General Appearance:clean and organized clean but cluttered visibly dirty and cluttered

Pets (please list types and numbers):

6) STUDENT’S BEDROOM

Does the student have his/her own bedroom?Yes No

If the student is sharing a room, with whom is he/she sharing?

What type of bed does student have? Single bed double bed bunk bed other

Does the student have adequate space to store his/her belongings? Yes No

Does the student have adequate study space in his/her room or elsewhere in the house? Yes No

7) GENERAL IMPRESSION

Would you (the SV) feel comfortable if your own child were placed with this family for a semester or an academic year? Yes No Comments?

Second Visitor’s Confirmation of Visit:By signing below, I confirm that I have performed this host family visit at the family’s home and on the date notedbelow. To the best of my ability I have truthfully provided all of the information and comments in an unbiased and objective manner.

Visit conducted by: / Second Visitor Name: / on [date]:
Signature: / Phone: / Email:

Please complete, sign and scan this form to NWSE at or fax to 800-717-9117

INDEPENDENT CONTRACTOR AGREEMENT

I, (signed below), agree to provide the following services to NWSE.

AGREED-UPON SERVICES AND PROCEDURES:

  1. Perform HOST FAMILY visit
  • Respectfully conduct an in-home visit at the residence of the NWSE-designated host family.
  • Conduct this in-home visit after the student has moved into the host family home (the student does not need to be physically present during the visit)
  • Report hosting arrangements as requested on the “Confidential Second Host Family Visit” (SHFV) form.
  • Offer no advice or feedback to the Host Family regarding any aspect of NWSE’s services or programs.
  • Instead, refer Host Family to NWSE (Seattle) program coordinators for all questions they may have.
  1. COMPLETE AND RETURN “CONFIDENTIAL SECOND HOST FAMILY VISIT” FORM TO NWSE:
  • Scan/email or fax completed and signed form to NWSE’s local academic coordinator and NWSE-Seattle within three days of the visit (or earlier if NWSE requests). Email: ; NWSE fax: 800-717-9117
  1. PREPARE FOR VISIT:
  • Review the entire attached “Confidential Second Host Family Visit” form.
  1. COMMUNICATE WITH NWSE:
  • Communicate in a timely manner with NWSE at all times regarding the SHFV.
  • Immediately report any potential problems or out-of-the-ordinary situations to NWSE.
  • Respond in a timely manner (same day) to email and phone messages regarding SHFV.
  1. COMPENSATION FOR SERVICES:
  • NWSE will compensate the independent contractor $50.00 per host family visit upon providing and NWSE receiving the above-described services.
  • Additional opportunities for compensation: Referral of U.S. Host Families= $150.00 per referred family that actually hosts an NWSE exchange student

Agreement:

I, the undersigned, understand that I am acting solely as an Independent Contractor. Nothing in this agreement shall be construed to create an employee, agency, partnership, joint venture or any relationship other than that of an independent contractor between NWSE and myself, and that this agreement cannot be assigned or transferred to any other person. I understand I am responsible for all expenses I may incur (e.g., mileage, phone) in providing these services.

Agreed-upon compensation shall be paid upon NWSE’s timely receipt of all services I am required to provide.

I hereby agree that all disputes that may arise from this Agreement shall be governed by and resolved in accordance with the laws of the State of Washington, USA. No other law shall be applicable. Any lawsuit arising out of this Agreement or in connection with this Agreement in any manner may only be brought in King County, Washington, USA. I hereby state and affirm that the procedures and expectations have been presented and fully explained to me to my full and complete understanding and satisfaction.

Signed:Date:

Printed Name:Phone number: ( )

E-mail

Mailing Address

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