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Host Family Application Form for 2020 CHSN Sister School Program
This information will only be shared by the teachers from Yuhigaoka HS, Mrs. Uchiyama and the Japanese student and his/her family in Japan individually.
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* Indicates required question
Email
*
Your email
Student's Full Name (first last)
*
Your answer
School
*
CHSN
CHSS
Student's grade
*
9
10
11
12
Which foreign language is the student currently taking?
*
ASL
French
Italian
Japanese
Spanish
None
Required
# of Family Members at your house during the Homestay Program
*
Your answer
Family Member 1 -- First Name
*
Your answer
Family Member 1 -- Age
*
Your answer
Family Member 1 -- Relationship to the student
*
ex. father, mother, older sister, etc.
Your answer
Family Member 1 -- Hobbies & Interests
*
Your answer
Family Member 2 -- First Name
*
Your answer
Family Member 2 -- Age
*
Your answer
Family Member 2 -- Relationship to the student
*
Your answer
Family Member 2 -- Hobbies & Interests
*
Your answer
Family Member 3 -- First Name
Your answer
Family Member 3 -- Age
Your answer
Family Member 3 -- Relationship to the student
Your answer
Family Member 3 -- Hobbies & Interests
Your answer
Family Member 4 -- First Name
Your answer
Family Member 4 -- Age
Your answer
Family Member 4 -- Relationship to the student
Your answer
Family Member 4 -- Hobbies & Interests
Your answer
Family Member 5 -- First Name
Your answer
Family Member 5 -- Age
Your answer
Family Member 5 -- Relationship to the student
Your answer
Family Member 5 -- Hobbies & Interests
Your answer
Home Address
*
Your answer
Home Phone Number
*
Your answer
Emergency Contact Person
*
Your answer
Emergency Contact Phone Number
*
Your answer
Will you provide a private room for the Japanese student?
*
Yes
No. She/he needs to share a room with our child.
No. She/he needs to stay in a common room.
Other:
Do you have any pets at home? How many?
*
Your answer
How does your child go to school?
*
school bus
gets a ride from a parent/guardian
she/he drives to school
bicycle
walking
gets a ride from a classmate
Other:
Required
How long does it take to commute to school in the morning?
*
ex. 20 min.
Your answer
Does your child participate in any after school activities at school or outside of school? If so, please list the activity/activities.
*
Your answer
Does your family have any food restrictions?
*
Your answer
Do you have any preference for whom you host? (18 girls and 2 boys from Japan)
*
prefer a boy
prefer a girl
either is fine
Required
Are you willing to host a second student?
*
Yes
No
Required
What time does your child usually get up in the morning during weekdays?
Your answer
What time does your child usually go to bed during weekdays?
Your answer
What language do you primarily speak in your home?
*
Your answer
Mrs. Uchiyama is planning to take the Japanese students and the host students to Ellis Ireland and Statue of Liberty (tentative) on Monday, March 16th. Do you want to participate in this all-day trip?
*
Yes
No
I'm not sure yet.
Please write a welcome message to the Japanese student in English and/or Japanese.
*
Your answer
Please write any questions or comments to Mrs. Uchiyama regarding this program.
Your answer
Submit
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