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Residence Partners
Employment Services

Building long-lasting relationships

Residence Partners
Employment Services

Building long-lasting relationships

Residence PartnersCarlos Peliceli2020-01-27T20:48:25-05:00

HOST FAMILY PROFILE

Host Parent Information

Home Parent 1

First Name *

Middle Name *

Last Name *

Date of Birth *

Gender * Male Female

Occupation: *

Email *

Phone*

Home Parent 2

First Name *

Middle Name *

Last Name *

Date of Birth *

Gender * Male Female

Occupation: *

Email *

Phone*

Address Information

House Number

Suite / Apt Number

Street Address

City

Province

Country

Family Information

Please list all other people currently living in the home:

First Name *

Last Name *

Relation *

Gender * Male Female

Date of Birth *

First Name *

Last Name *

Relation *

Gender * Male Female

Date of Birth *

First Name *

Last Name *

Relation *

Gender * Male Female

Date of Birth *

First Name *

Last Name *

Relation *

Gender * Male Female

Date of Birth *

Will there be any visitors/international students/room and board to your home during your students stay? If so, please list:

Name *

Relation to Hosts *

Age *

Gender * Male Female

Length of Stay *

Name *

Relation to Hosts *

Age *

Gender * Male Female

Length of Stay *

Name *

Relation to Hosts *

Age *

Gender * Male Female

Length of Stay *

Name *

Relation to Hosts *

Age *

Gender * Male Female

Length of Stay *

Home Information

What is the style of your home? Describe briefly.*

Number of Bedrooms?*

Number of Bathrooms?*

Home Pets

Do you have any pets? *

If yes please list:

CAT

Number*

Breed*

Indoor*

Outdoor*

DOG

Number*

Breed*

Indoor*

Outdoor*

OTHER

Number*

Breed*

Indoor*

Outdoor*

Home Photo

Please provide some photos of the host family and exterior of the home. We encourage you to get creative with your photo collage, but please keep in mind the collage requires the following:

• A minimum of 4 photos
• Photos must be of good quality and a decent size - they should be clear, crisp and visible; not blurry or distorted. • A description for each photo (tell us names of who/what is in the photo, what you are doing, where you are - anything you think is important!)
• Photos must be contained in a document (multiple pages is ok!) so it is easy for us to send the collage along to your potential host family. We’ve found that an easy way to put the collage together is to use Microsoft Word or a similar program to paste photos and descriptions in.

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We'd Love To Hear From You!

First Name *

Last Name

Cell Phone Number

Email Address

Country of Residence

Type of Service

Referred By

First Name *

Last Name

IDCI will not use you personal information without your permission

Please contact me to assist my inquiry.

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Phone Email

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Best Time to Call

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