Madisonhs.fcps.edu



HOST/STUDENT APPLICATION FORMStudent Name:? _________________________________________________________? Grade: _______________Address:? __________________________________________________________________________________Preferred contact phone numbers of parent or guardian:_______________________ circle one (home, cell, work) _______________________ circle one (home, cell, work)Student email address (print neatly!) _____________________________________________________________Parent or guardian email address (print neatly!) _____________________________________________________HOUSING ARRANGEMENTS AVAILABLE FOR GUESTSPlease indicate the type of living arrangements you will provide for our Korean guests:?Shared bedroom for 2 same sex guestsSeparate bedrooms for each student Separate bathroom for guest use onlyShared bathroom with the host familyGuest bedroom(s) located above ground levelGuest bedroom(s) located below ground level Wi-Fi available for guest useACKNOWLEDGEMNET OF AGREEMENT OF UNDERSTANDING FOR POTENTIAL HOST FAMILIESIf selected, we understand and agree to the following:We understand we will be hosting two students from JungHwa Girls School in our home during the week of January 16-23, 2020.All household members over the age 18 shall submit to a background check through FCPS.??Our Korean guests shall be provided with appropriate sleeping arrangements (i.e., their own individual beds, etc).If hosting students of the opposite sex, guests shall be provided with their own separate bedrooms.???As a host family, we agree to provide students all miscellaneous expenditures (i.e. meals, movie tickets, transportation fees, etc.) during their stay.Students of the host family will be expected to visit JungHwa Girls School during Spring Break (approximately April 4-13, 2020).The cost of the program of approximately $1,100 (a total value of well over $3,500.00) will be due on or before December 13th. (checks payable to JMHS)??Host Parent Signature:? _______________________________________Date:? ____________Student Signature:? _______________________________________ Date:? ____________ ................
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