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Host Application Form
Host Application Form
Host Family Information:
Name:
(Required)
First
Last
Phone:
(Required)
Email:
(Required)
Address:
(Required)
Street Address
City
State / Province / Region
ZIP / Postal Code
Members of Family:
(Required)
Language's Spoken:
(Required)
Household Pets:
(please list type and numbers)
Non-Smoking:
Available Space:
(Required)
Description of Your Family:
Motivation for Wanting to Host:
Time Frame Available for Hosting:
(Required)
Family Interest Inventory:
Male
Female
LGBTQ+
Halal
Kosher
Atheist
Religious
Does not speak English
Experienced Trama
Physical Challenges
Allergic to Animals
Smokes
Meat Eater
Vegetarian
Other (please specify to the right)
Check all guest traits that would be acceptable with your family.
"Other" (please specify)
References:
Name:
Relationship:
Phone:
Name:
Relationship:
Phone:
Name:
Relationship:
Phone:
Clearances (for all household members older than 18)
Pennsylvania Child Abuse History Clearance
(free for volunteers)
Pennsylvania State Police Criminal History Clearance
(free for volunteers)
Federal Bureau of Investigations (FBI) Criminal History Clearance
Approx. $25
Clearance Documents:
Drop files here or
Select files
Accepted file types: pdf, doc, docx, jpg, jpeg, Max. file size: 50 MB, Max. files: 15.
(You can submit these at a later time too)
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