Instructions to Fill out and Submit This Form

Form D: Host Family Interview

Instructions to fill out and submit this form:

1. Fill out form using a computer

2. ‘Save’ form to your computer

3. Click on ‘upload/fill in app form’ in the Host Family Online Application in Global Link

4. ‘Create’ Form D: Host Family Interview

5. Browse your computer for the saved file and ‘upload’

Prior to the interview, please review the Host Family's application to determine if any of the required photos have yet to be submitted. If so, we encourage you to take and submit these photos on behalf of the family.

Please note: only currently registered AFS volunteers can conduct the Host Family interview.

Host Family First/Last Name / Area Team / Date of Interview

FAMILY ASSESSMENT:

Based on your interview, which of the following attributes do you feel most accurately describe the family?

casual home humor individual pursuits
sports/outdooractivities low-key, quiet home father-dominant home
intellectual pursuits neatness openness with feelings
mother-dominant home family-centered activities decision-making by family consensus
much communication planned/organized home spontaneity
active participation in decision-making role assumed other
community/volunteer functions by parents

If other, please explain:

1(a). Please provide a brief description of the family’s typical weekly schedule.

1(b). How much time will the student spend alone during a typical week?

2. Is the family prepared to take on the added responsibility of an exchange student, including providing adequate food, clean and safe housing, and supervision? yes no If no, please explain:

3. Is the family prepared to accept the cultural and religious differences of the exchange student that they host? yes no

If no, please explain:

4. How would you describe the communication style of the family (for example, willingness to accept input from all family members, flexibility)?

5. A host family may want the exchange visitor to attend one or more religious services or programs with the family, and as part of the exchange, students are encouraged to experience this facet of U.S. culture. However, attendance of religious services with their host family cannot be mandatory, and whether or not to attend is entirely at the discretion of the student. Please ensure the family is clear that students cannot be required to attend religious services and note any related concerns in the below field.

Does the family agree they will not make attendance to religious services mandatory for their student?

Yes No If no, please explain:

6. Which family member initiated the idea of hosting?

7. Based on your interaction with the family, do you feel that all members are interested in and enthusiastic about hosting?

Yes No If no, please explain:

8. Has the family ever had a negative hosting experience with AFS or another organization in the past? Yes No

If yes, please explain:

9. Will any family members be away during the hosted student’s time in the home (including vacation at time of
arrival)? Yes No If yes, explain who, dates away, and if this will affect hosting:

Host Family First/Last Name / Area Team / Date of Interview

10(a). Was the interview conducted in the host family's home?Yes No

10(b). Was everyone living in the home present at the interview? Yes No

If no, list names of household members that were not in attendance.

If no, when will/did follow up take place with anyone not present?

11. What personal expenses will be expected to be covered by the AFSstudent?

* AFS and the U.S. Department of State require that all household members be interviewed.

* Note that follow up can take place over the phone and be submitted to staff as an addendum at a later date.

12. Will family be able to provide necessary transportation for extracurricular activities after school or in the evenings? Yes No

If no, who can provide this?

13.Is this a single adult placement (single person, no children in the home)? Yes No

If this is a single adult placement (single person, no children in the home) please comment on the individual’s ties to the community (friends or family) that could provide additional support to the exchange student if necessary (i.e. pick student up from school if the host parent is working late, not feeling well, etc.):

HOME ASSESSMENT:

1. How would you best describe the type of housing in which the family resides?

single family homeapartment buildingmulti-plexmobile homecondo

2. Please rate the overall condition of each of the following. If rating is fair or poor provide an explanation:

a) Outside of the property: Poor Fair Average Above average Excellent

Additional comments:

b) Kitchen: Poor Fair Average Above average Excellent

Additional comments:

c) Bathroom(s): Poor Fair Average Above average Excellent

Additional comments:

d) AFSstudent’s bedroom: Poor Fair Average Above average Excellent

Additional comments:

e) Living areas: Poor Fair Average Above average Excellent

Additional comments:

f) Dining area(s): Poor Fair Average Above average Excellent

Additional comments:

g) Other: Poor Fair Average Above average Excellent

Additional comments:

h) Are the photos that were uploaded into the Host Family’s application consistent with what you observed in the home?

Yes No photos not submitted prior to interview

If no, please comment:

i) Does the bedroom that the student will use contain a window or a door that leads directly to the exterior of the home and that would provide adequate exit in the event of a fire or other emergency?

Yes No

If not, please explain?

Host Family First/Last Name / Area Team / Date of Interview

j) Will the student have adequate storage for their things in their room?

Yes No

If not, pleasecomment?

3. Does the family have pets? Yes No

If yes, please describe what type(s) of pet(s), parts of the house they have access to, where they sleep, and comment on any

noticeable pet odor or excessive hair around the house:

4. Comment on any placement recommendations or restrictions.

5. Based on the assessment outlined above, does this chapter and/or this writer believe there is adequate commitment and resources in this family for a successful hosting experience? Yes No If no, please comment:

6. Are you currently a registered AFS volunteer? Yes No

Writer’s Name / AFS Position / Signature(e-signature accepted) / Date

Volunteer should please upload the completed form to Global Link

If you need assistance, call your territory’s Hosting Operations Coordinator

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