Nagano Student Exchange - Host Family Interest Form

Nagano Student Exchange - Host Family Interest Form

Families interested in hosting an exchange student from Nagano City, Japan, may fill out this interest form at any point in the year. Families selected to participate in the host family program will be contacted 2-3 months before students are expected to arrive in Clearwater to confirm availability and interest.

Please contact Amber Brice at Amber.Brice@MyClearwater.com with any questions.

Applicant Contact Information

First Name*

Last Name*

Mailing Address*

Phone Number*

Phone

Email Address*

Household Information

Members of Household*

Please include all members of household with ages/grades of youth

Pets*

Please include all pets/animals in household

Schools Attended*

By youth in household

Activities Involved In*

Please list all activities the family or youth in household ar involved in that the exchange student might participate in (ex. soccer practice, volunteering, after school clubs, etc.)

Allergies/Dietary Restrictions*

Please list all allergies or dietary restrictions of household

Transportation*

Please list how an exchange student will be transported to/from school, activities and scheduled programs

Accommodations*

Where will the exchange student be sleeping?

Additional Comments*

Is there anything else you would like to add about your home/family?

Past Exchange Student Experience

Has a student in this household traveled to Nagano as an exchange student in the past?*

Please list name(s) of student(s) and year(s)

Has this household hosted an exchange student from Nagano in the past?*

Please list name(s) of student(s) hosted and what year(s)

Acknowledgements

All members of the household over 18 are willing and able to complete a city, state, and federal background check.*

I certify that all information in this application is true and accurate to the best of my knowledge.*

Signature*

First and last name of applicant

Today's Date*

Send me a copy of my responses

Privacy Notice|Report Abuse