UPC Host Family Application

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Ulster Project of Cincinnati Host Family Application:
Please fill out as much as possible. We will use many of these answers to help match you with a guest teen if you are selected as a host family.
UPC will contact you to schedule an interview to take place in your home with the whole family. Host parents and anyone in the household over the age of 18 will be asked to have a background check completed. Following the home interview, there will be an additional group teen interview session scheduled in late fall.l

If you have questions, please contact us at info@ulsterprojectcincinnati.org

Section 1: To be completed by HOST PARENTS

Host Teen's First Name

Host Teen's Last Name

Mother's First Name

Mother's Last Name

Father's First Name

Father's Last Name

Full Address (street, city, state, zip)

Do parents live together

Yes

Clear selection

If not, Father's Full Address

If not, which house will be hosting?

Mom

Dad

Other:

Clear selection

MOTHER'S INFO:

Mother's Email Address

Mother's Cell Phone Number

Occupation: Mother

Employer: Mother

FATHER'S INFO:

Father's Email Address

Father's Cell Phone Number

Occupation: Father

Employer: Father

FAMILY INFO

Name of Church Family Attends:

Is this a Catholic church or Protestant?

Catholic

Protestant

Other:

Clear selection

Youth Minister or Pastor

Do you have any pets? *

Yes

If yes, please specify:

Does anyone smoke inside your home?

Yes

Clear selection

Please list the names and ages of any siblings:

Clear form

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