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Online Host Family Application
Thank you for your interest in hosting a foreign exchange student.
Hosting an exchange student is a wonderful opportunity to experience another culture, impact the life of a student, and make a difference in today’s world. The first step of hosting begins with the Host Family Application. In addition, the screening and student placement process includes the following steps:
Host Family Application
Criminal Background Check
Home Visit
School Acceptance
Student Selection of Host Family
Host Family Responsibilities and Agreement Form Review
Host Family Orientation
Student Arrival
In order to meet quality standards for Summa Global Education (“Summa”) hosting programs, comply with U.S. Department of State regulations for secondary student exchange programs, and - most of all - to assure the natural parents that their children are placed in appropriate host families, all families must be thoroughly screened and vetted. We are confident you would want the same assurance if a family in another country were hosting you or your child.
@include('partial.input', array( 'id'=>'inputHowLearnAnBEducations', 'title'=>'How did you learn about AnB Educations foreign exchange program? (* required)', 'class'=>'DVHQ' ) )
@include('partial.select', array( 'layout'=>'mt15', 'id'=>'selectEduSchoolState', 'title'=>'Please select your location and closest AnB Education school', 'selectList'=>$ar_school_states ) )
@include('partial.input', array( 'formId'=>'formDistSchMore', 'layout'=>'mt15', 'style'=>'display:none;', 'id'=>'inputDistSchMore', 'title'=>'then, type your distance form school(minute)') )
Please submit your completed copy of this application and required photos to Summa’s national office by e-mail to: contact@anbeducation.com
A Summa representative will contact you regarding the next steps in the screening process.
{{--host father--}}
Host Father Information
@include('partial.input', array( 'layout'=>'mt15','size'=>'col-lg-6', 'id'=>'inputHostFatherFirstName', 'title'=>'Host Father First Name', 'class'=>'DVNA' ) )
@include('partial.input', array('layout'=>'mt15', 'size'=>'col-lg-6', 'id'=>'inputHostFatherLastName', 'title'=>'Host Father Last Name', 'class'=>'DVNA' ) )
@include('partial.dateform', array( 'id'=>'selectHostFather', 'title'=>'Host Father Date of Birth' ) )
@include('partial.select', array( 'layout'=>'mt15', 'id'=>'selectHostFatherOccupation', 'title'=>'Host Father Occupation: If retired, please include the industry you have retired from.', 'selectList'=>$ar_job_list ) )
@include('partial.input', array( 'layout'=>'mt15','inputStyle'=>'display:none;', 'id'=>'inputHostFatherOccupationExplain', 'title'=>'', 'placeholder'=>'Please Explain') )
@include('partial.input', array( 'layout'=>'mt15','size'=>'col-lg-6', 'id'=>'inputHostFatherWorkPhoneNumber', 'title'=>'Host Father Work Phone Number', 'class'=>'DVNA integer', 'maxlength'=>'11' ) )
@include('partial.input', array( 'layout'=>'mt15','size'=>'col-lg-6', 'id'=>'inputHostFatherCellPhoneNumber', 'title'=>'Host Father Cell Phone Number', 'class'=>'DVNA integer', 'maxlength'=>'11' ) )
@include('partial.select', array( 'layout'=>'mt15', 'id'=>'selectHostFatherLevel', 'title'=>'Host Father Level of Education', 'selectList'=>$ar_edu_level ) )
@include('partial.input', array( 'layout'=>'mt15', 'id'=>'inputHostFatherCrime', 'title'=>'Have you ever committed a crime, etc? If so, please explain.', 'class'=>'DVNA', 'maxlength'=>'300' ) )
{{--host mother--}}
Host Mother Information
@include('partial.input', array('size'=>'col-lg-6', 'id'=>'inputHostMotherFirstName', 'title'=>'Host Mother First Name', 'class'=>'DVNA' ) )
@include('partial.input', array('size'=>'col-lg-6', 'id'=>'inputHostMotherLastName', 'title'=>'Host Mother Last Name', 'class'=>'DVNA' ) )
@include('partial.dateform', array( 'id'=>'selectHostMother', 'title'=>'Host Mother Date of Birth' ) )
@include('partial.select', array( 'layout'=>'mt15', 'id'=>'selectHostMotherOccupation', 'title'=>'Host Mother Occupation: If retired, please include the industry you have retired from.', 'selectList'=>$ar_job_list ) )
@include('partial.input', array( 'layout'=>'mt15','inputStyle'=>'display:none;', 'id'=>'inputHostMotherOccupationExplain', 'title'=>'', 'placeholder'=>'Please Explain') )
@include('partial.input', array( 'layout'=>'mt15', 'id'=>'inputHostMotherCrime', 'title'=>'Have you ever committed a crime, etc? If so, please explain.', 'class'=>'DVNA', 'maxlength'=>'300' ) )
@include('partial.radio', array( 'size'=>'col-xs-3', 'name'=>'radioLiveWithChild', 'title'=>'Does the child live in the house hold with you?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
@include('partial.radio', array( 'size'=>'col-xs-3', 'class'=>'radioRequired' , 'name'=>'radioChild18Older', 'title'=>'* Is the child 18 or older OR will child turn 18 years of age during the placement of Exchange students stay?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
All Members of the House Hold 18 years of age or older must consent to a Criminal Background Check according to the rules of the department of state.
@include('partial.radio', array( 'size'=>'col-xs-3', 'class'=>'radioRequired' , 'name'=>'radioResiding', 'title'=>'Do you have House Hold members over the age of 18 residing in the house hold?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
All Members of the House Hold 18 years of age or older must consent to a Criminal Background Check according to the rules of the Department of State.
@include('partial.select', array( 'layout'=>'', 'id'=>'selectNumberOfMember', 'title'=>'Number of Member', 'selectList'=>$ar_one_to_ten ) )
@include('partial.select', array( 'layout'=>'mt15', 'id'=>'selectMemberEducationLevel'.$j, 'title'=>'Level of Education', 'selectList'=>$ar_edu_level ) )
@endfor
{{--Financial Disclosure--}}
Financial Disclosure
Note: The income data collected will be used solely for the purposes of ensuring that the basic needs of the exchange students can be met, including three quality meals and transportation to and from school activities. No credit check will be completed during criminal background check.
@include('partial.radio', array( 'layout'=>'mt15', 'size'=>'col-md-3', 'name'=>'radioAverageIncome', 'title'=>'Average annual Income range', 'radioContents' => $ar_financial_list ) )
@include('partial.radio', array( 'layout'=>'mt15', 'size'=>'col-md-3', 'name'=>'radioReceiveGovernmentSubsidies', 'title'=>'Does anyone residing in the home receive any kind of financial needs-based government subsidies for food or housing?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
{{--References--}}
References
Please list two references that have known your family for at least 12 months. Under the Department of State rules and regulations, relatives or Summa field staff cannot be used as a reference.
@include('partial.radio', array( 'size'=>'col-xs-3', 'name'=>'radioDietaryRestrictions', 'title'=>'Does anyone in the family follow any dietary restrictions?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
host family to provide the student with two (2) Square Meals a day during school days (Student will purchase lunch at school), and three (3) Square meals on non-school days
{{--transportation--}}
Transportation
@include('partial.checkbox', array( 'size'=>'col-md-4', 'layout'=>'mt15', 'class'=>'leastOneCheck' ,'title'=>'* How will the exchange student get to the school?', 'checkContents' => $ar_exchange_to_the_school ) )
@include('partial.radio', array( 'size'=>'col-xs-3', 'layout'=>'mt15', 'name'=>'radioFamilyProvideSpecialTransportation', 'class'=>'radioRequired', 'title'=>'* Would the family provide special transportation for extracurricular activities after school or in the evenings, if required?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
@include('partial.radio', array( 'size'=>'col-xs-3', 'layout'=>'mt15', 'name'=>'radioIsTherePublicTransportation', 'class'=>'radioRequired', 'title'=>'* Is there public transportation to the school or is the schools close enough to your home that the student could walk to and from activities?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
@include('partial.input', array( 'layout'=>'','size'=>'', 'id'=>'inputIsTherePublicTransportationExplain', 'title'=>'If you No, Please Explain', 'maxlength'=>'50', 'class'=>'' ) )
@include('partial.radio', array( 'size'=>'col-xs-3', 'layout'=>'mt15', 'name'=>'radioWorkForHighSchool', 'class'=>'radioRequired', 'title'=>'* Does any member of your household work for the high school in a coaching, teaching, or administrative capacity?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
{{--Community Information--}}
Community Information
@include('partial.radio', array( 'size'=>'col-xs-3', 'layout'=>'mt15', 'name'=>'radioCommunityLive', 'class'=>'radioRequired', 'title'=>'* In what type of community do you live?', 'radioContents' => ['Urban'=>'Urban', 'Suburban'=>'Suburban', 'Rural'=>'Rural', 'Farm'=>'Farm'] ) )
@include('partial.radio', array( 'size'=>'col-xs-3', 'layout'=>'mt15', 'name'=>'radioWalkBikeEasily', 'class'=>'radioRequired', 'title'=>'* Can a student walk or bike easily?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
@include('partial.radio', array( 'size'=>'col-xs-3', 'layout'=>'mt15', 'name'=>'radioPublicTransportationAvailable', 'class'=>'', 'title'=>'Is there convenient public transportation available to a major city?', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
@for ($j = 1; $j <= 2; $j++)
@endfor
@include('partial.checkbox', array( 'size'=>'col-md-4', 'layout'=>'mt15', 'class'=>'leastOneCheck' ,'title'=>'* How will the exchange student get to the school?', 'checkContents' => $ar_interest_area ) )
@include('partial.input', array( 'formId'=>'formInterestPoint', 'layout'=>'mt15', 'style'=>'display:none;', 'id'=>'inputInterestPointExplain', 'title'=>'Explain', 'maxlength'=>'300') )
{{--Home Description--}}
Home Description
@include('partial.radio', array( 'size'=>'col-xs-4', 'layout'=>'mt15', 'name'=>'radioHomeType', 'class'=>'radioRequired', 'title'=>'* Describe your type of home:', 'radioContents' => ['Single'=>'Single Family Home', 'Condominium'=>'Condominium', 'Duplex'=>'Duplex', 'Apartment'=>'Apartment', 'Mobile'=>'Mobile Home'] ) )
@include('partial.input', array( 'layout'=>'','size'=>'col-md-6', 'id'=>'inputBedNo', 'title'=>'Number of Bedrooms', 'class'=>'' ) )
@include('partial.input', array( 'layout'=>'','size'=>'col-md-6', 'id'=>'inputBathNo', 'title'=>'Number of Bathrooms', 'class'=>'' ) )
@include('partial.checkbox', array( 'size'=>'col-md-4', 'layout'=>'mt15', 'class'=>'leastOneCheck' ,'title'=>'* Describe the student’s bedroom: Please note that the student must have their own room on the ground floor or higher (no basement rooms)', 'checkContents' => $ar_student_bedroom ) )
@include('partial.input', array( 'formId'=>'formDescStudentBedroom', 'layout'=>'', 'style'=>'display:none;', 'id'=>'inputDescStudentBedroomExplain', 'title'=>'Explain', 'maxlength'=>'50') )
@include('partial.checkbox', array( 'size'=>'col-md-4', 'layout'=>'mt15', 'class'=>'leastOneCheck' ,'title'=>'* Describe amenities to which the student has access:', 'checkContents' => $ar_amenities ) )
@include('partial.input', array( 'formId'=>'formDescAmenities', 'layout'=>'', 'style'=>'display:none;', 'id'=>'inputDescAmenitiesExplain', 'title'=>'Explain', 'maxlength'=>'50') )
@include('partial.radio', array( 'size'=>'col-xs-4', 'layout'=>'mt15', 'name'=>'radioFunctioningBusiness', 'class'=>'radioRequired', 'title'=>'* Is the residence the site of a functioning business?', 'radioContents' => $ar_residence_site ) )
@include('partial.input', array( 'formId'=>'formFuncBusiness', 'layout'=>'', 'style'=>'display:none;', 'id'=>'inputFuncBusinessExplain', 'title'=>'Please Explain') )
{{--Household Pets--}}
Household Pets
{{--Family Activities--}}
Family Activities
@include('partial.checkbox', array( 'size'=>'col-md-4', 'layout'=>'mt15', 'class'=>'leastOneCheck' ,'title'=>'* Please describe activities and/or sports each family member participates in, please feel free to elaborate further in the note to your student:', 'checkContents' => $ar_desc_activities ) )
@include('partial.input', array( 'formId'=>'formDescActivities', 'layout'=>'', 'style'=>'display:none;', 'id'=>'inputDescActivitiesExplain', 'title'=>'Explain', 'maxlength'=>'50') )
@include('partial.radio', array( 'size'=>'col-xs-4', 'layout'=>'mt15', 'name'=>'radioWilling', 'class'=>'', 'title'=>'Are you willing to disclose the religious affiliations of your household members to the student in advance?', 'radioContents' => $ar_willing ) )
@include('partial.checkbox', array( 'formId'=>'formWilling', 'style'=>'display:none;', 'size'=>'col-md-4', 'layout'=>'mt15','title'=>'Please describe activities and/or sports each family member participates in, please feel free to elaborate further in the note to your student:', 'checkContents' => $ar_willing_type ) )
@include('partial.input', array( 'formId'=>'formWillingExplain', 'layout'=>'', 'style'=>'display:none;', 'id'=>'inputWillingExplain', 'title'=>'Explain', 'maxlength'=>'50') )
@include('partial.radio', array( 'layout'=>'mt50', 'size'=>'col-xs-3', 'name'=>'radioReligiousBeliefs', 'title'=>'* Would any member of the household have difficulty hosting a student whose religious beliefs were different from their own?', 'class'=>'radioRequired', 'radioContents' => ['Yes'=>'Yes', 'No'=>'No'] ) )
Note: A host family may want their exchange student to attend one or more religious services or programs with the family. The exchange student cannot be required to do so, but may decide to experience this facet of U.S. culture at his or her discretion.
@include('partial.radio', array( 'size'=>'col-xs-4', 'layout'=>'mt15', 'name'=>'radioHostingInternationalStudents', 'class'=>'radioRequired', 'title'=>'* Are you now hosting an international student?', 'radioContents' => $ar_international_students ) )
Please upload the following Images: (Indicate file formats compatible with program)
The U.S. Department of State requires that photographs of the host family home’s exterior and grounds, kitchen, student’s bedroom, student’s bathroom, and family and living areas be included in this application. Please submit the photos either by email or hard copy.
I, the undersigned, have, to the best of my knowledge, answered the questions in this application form accurately and truthfully. I understand that knowingly and willfully providing false information to Summa will result in immediate expulsion from the program and possible legal action.