HOST FAMILY REFERENCE

CONFIDENTIAL HOST FAMILY REFERENCE

This family has applied to host an international student with Pursue Languages. A host family represents the U.S. culture to the visitor and plays a very important role in determining the success of the participants’ experience in the United States. The information that you provide will be useful in determining the placement of individual participants. All information is confidential and will only be used to select host families. Thank you.

Name of Potential Host family you are completing the form for.

Address

Street City State ZIP

Telephone Home

Work/Cell Phone

Name of the person completing the form

Address

Street City State ZIP

Telephone Home

Work/Cell Phone

How long have you known this family?

How often do you see the family?

What is your relationship with this family?

What special interests (camping, horses, art, cooking, sports, etc.) do family members have, especially the teenager(s)?

How do you feel this family will adjust to unexpected situations, different customs, etc?

How do you feel that this family will welcome a visitor of a different religion and different ethnic background?

What are this family’s greatest strengths?

What are this family’s weaknesses?

Are you aware of any drug, alcohol, or child abuse on the part of any member of the family?

Yes
No

If yes, please explain:

In your opinion, would a young visitor find this family supportive and understanding of difficulties in adjusting to strange customs, new foods, interpersonal relationships, etc? Please give an overall assessment. If you have a son or daughter age 12-18, would you feel comfortable if your child were placed with this family?

Would you recommend this family to host a participant?

Very Strongly
Yes
With some hesitation
No

Signature

Date

Protección de Datos

Responsable: PURSUE LANGUAGES, S.L
Finalidad: prestar los servicios que nos ha solicitado, atender sus solicitudes de información y enviarle comunicaciones comerciales.
Legitimación: interés legítimo y relación contractual entre ambas partes.
Destinatarios: No se cederán datos a terceros, salvo obligación legal.
Derechos: podrá ejercitar los derechos de acceso, rectificación, cancelación y oposición, así como los demás derechos que recoge el citado reglamento, para lo cual debe dirigirse a PURSUE LANGUAGES, S.L por correo electrónico a ewambu@pursuelanguages.com
Procedencia: El propio interesado.
Para información adicional de segunda capa visitar: https://pursuelanguages.com

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