JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
GlobalPittsburgh Host Family Application
Thank you for your interest in joining GlobalPittsburgh as a host family! By opening your home to international students and leaders, you are expanding your world and gaining a unique opportunity to make lifelong friendships. You can learn more about our hospitality programs on our
website
and from the GlobalPittsburgh Host Family
Guidebook
.
Helpful information about hosting visitors in your home can be found on page 10 of this
guidebook
.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
In which hosting opportunities are you interested?
*
Dinners (lunches) for international leaders in my home
Homestays
Other (please explain below)
Required
Comments:
Your answer
Date of application
*
MM
/
DD
/
YYYY
How did you hear about GlobalPittsburgh?
*
Your answer
Your Name
*
Your answer
Home Phone
Your answer
Cell Phone
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Your answer
ZIP Code
*
Your answer
Date of Birth
*
Your answer
Marital Status:
*
Married
Single
Divorced
Widow
Have a partner who lives with me
Have a partner who does not live with me
Do you have children?:
*
Yes
No
If employed, your current employer:
*
Your answer
Title:
*
Your answer
Regular Work Schedule and Hours
*
Your answer
Work address
Your answer
Phone:
Your answer
Education
*
Your answer
What are your hobbies and interests?
*
Your answer
What languages do you speak besides English?
Your answer
If you have traveled internationally, what countries have you visited/lived in?
Your answer
What type of cuisine do you generally prepare for dinner (American, Asian, Italian, Kosher, vegetarian, vegan, etc.)?
Your answer
Does your family have any food sensitivities or allergies?
*
Yes
No
Other:
If yes, please explain so that we may inform your potential guests
Your answer
Is your home accessible by public transportation?
*
Yes
No
Please explain your answer (e.g., closest bus or T stop)
Your answer
Would you prefer to host:
*
Female
Male
Either
What is the minimum age of a guest that you will be willing to host?
*
Your answer
Are there any restrictions of which you would like us or your guest to be aware?
Your answer
Does your family have (a) cat(s)?
*
Yes
No
If yes, how many, breed, etc.?
Your answer
Does your family have (a) dog(s)?
*
Yes
No
If yes, how many, breed, etc.?
Your answer
Do you or any member of your family smoke? Please note, if you or any family member smokes inside the house we will not be able to place students with you.
*
Yes
No
Would you host a student who smokes?
*
Yes, outside only
No
Do you have wifi in your home?
*
Yes
No
Will your guest(s) have a private bathroom? (Applicable to homestays. Write n/a if planning to host dinners only)
*
Your answer
Will laundry facilities be available to your guest? (Applicable to homestays. Write n/a if planning to host dinners only)
*
Yes
No
List any other facilities that will be available for your guest to use. (Applicable to homestays. Write n/a if planning to host dinners only)
Your answer
How many bedrooms are available for your guest(s)?
*
1
2
3
4
n/a (I am only interested in hosting dinners)
Other:
How many guests can you host at the same time? (Applicable to homestays only. Select n/a if you are not planning to provide overnight homestays)
*
1
2
3
4
n/a
Other:
Our monthly rates for hosting homestays (overnight guests) are
- $570 with no meals;
- $780 with breakfast and dinner;
- $885 with breakfast, dinner and a packed from home lunch. Please refer to a host family guidebook for more information about the meals requirement.
* Please note, our compensation rates reviewed yearly.
Please check all options that you would consider:
*
Homestay with no meals
Homestay with breakfast and dinner
Homestay with breakfast, dinner and a packed from home lunch
n/a (I am only interested in hosting dinners)
Other:
Required
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Globalpittsburgh.org.
Report Abuse
Forms
