HOST FAMILY RECOMMENDATION FORM
ACADEMIC YEAR PROGRAM
The following family has applied to host a foreign exchange student and has indicated you as a reference. We
appreciate your sincere comments and answers to the following questions. Your responses are very important to the
integrity of our program. Your recommendation is one consideration used to evaluate the appropriateness of the
family. Please tell us if you have any doubts about this family hosting. All information will be held in strict confidence.
Please return this form as soon as possible. Thank you very much for your time and cooperation.
Host Family __________________________________________________ Telephone __________________________
Address _______________________________________ City ______________________ State _______ Zip _________
RECOMMENDER INFORMATION
Full Name ____________________________________________________ Telephone __________________________
Address _______________________________________ City _____________________ State _______ Zip __________
How long have you known this family? _______________ What is your relationship to the family?_________________
RECOMMENDATION
□
To the best of your knowledge:
Has any family member been convicted of a misdemeanor or felony?
Has any family member had a complaint filed with an agency for child mistreatment?
Has any family member had involvement with illegal drugs?
*If any of the answers were “yes” to the above questions, please explain below
□
4
Indicate your opinion of the following:
Excellent
Family’s willingness and ability to provide student with good experiences
Family closeness, warmth, enthusiasm . . . . . . . . . . . . . . . . . . . .
Stability of individuals within the family . . . . . . . . . . . . . . . . . . .
Interests and activeness of family . . . . . . . . . . . . . . . . . . . . . . .
Community involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Adequacy of housekeeping . . . . . . . . . . . . . . . . . . . . . . . . . .
Would you feel comfortable if your own child were to stay with this family?
Yes
Yes
Yes
Yes
3
Good
No
No
No
2
Fair
1
Poor
No *If no, please explain
* Please write your recommendation including comments on any of the above items. (use reverse side if necessary)
________________________________________________________________________________________________
________________________________________________________________________________________________
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Please call me to discuss this information
I, or a student/family I know, would like more information about your programs
Signature______________________________________________________________ Date _____________________
For Local Representative use only:
This information was obtained by phone conversation with the above individual. LR Initials: ____________ Date: ____________
Nacel Open Door • 380 Jackson St., Ste. 200 • St. Paul, MN 55101 USA • Tel. 800-622-3553 • Fax: 651-286-0542
www.nacelopendoor.org • [email protected]
L:\Docs\Long Term\AYP Forms\HF Forms\word doc versions 2.0\”Host Family Recommendation Form” – updated 3.1.13