Adolesco | Application NA 2.2.2

Parent #1 (living with child)
- Mother
- Step-mother
- Father
- Step-father
Name
First Last
Known As (if different)
Date of Birth
Month
Day
Year
Place of Birth
Are you a native English speaker?
Divorced?
Separated?
Do you have any disabilites or health problems?
Do you smoke?
If yes, how many per day?
In the house?
Religion? Practicing? Other form of spirituality?
How would you describe your character?
Occupation (at present); Please give details, including hours and arrangements for child care if applicable
Occupation during the exchange (if different):
Hobbies and Interests:
Your level of education:
How well do you speak (don't be modest):
German
Spanish
French
As a child, did you ever spend time in a foreign country?
If yes, where and for how long?

Parent #2 (living with child)
- Mother
- Step-mother
- Father
- Step-father
Name
First Last
Known As (if different)
Date of Birth
Month
Day
Year
Place of Birth
Are you a native English speaker?
Divorced?
Separated?
Do you have any disabilites or health problems?
Do you smoke?
If yes, how many per day?
In the house?
Religion? Practicing? Other form of spirituality?
How would you describe your character?
Occupation (at present); Please give details, including hours and arrangements for child care if applicable)
Occupation during the exchange (if different):
Hobbies and Interests:
Your level of education:
How well do you speak (don't be modest):
German
Spanish
French
As a child, did you ever spend any time in a foreign country?
If yes, where and for how long?

The Family Home
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
How far do you live from the nearest town or city? (i.e., 20 miles/km from Denver/Toronto)
Home Phone
How late may we call in the evening (your time)?

: Hours

Minutes

AM/PM
Number of people living in the house during the week:
...and on the weekend
Your home is:
...located on:
and is:
Do you have a yard/garden?
Approximate size of yard/garden:
While hosting, the exchange partner (visiting) child will...
If the children will share, approximately how large is the room that will be shared?
Do you allow your child(ren) to leave the house unaccompanied, either during the day or at night?
If yes, please describe:
How many cars do you have?
How many bicycles?
Do you have (select all that apply)...
- Television
- DVD player
- Video game system
- Piano
Any pets? What kind(s) and how many?
Do you have any firearms in the house?
If yes, please explain:

Daily Life
In order to better understand your family and for the exchange child to better adapt to a new family, it helps to know something about your daily habits and expectations. There are no right or wrong answers to these questions, so please be honest
When your children misbehave or do something against the rules, how do you discipline them? Do you tend to let things sort themselves out or do you react immediately?
How do you react when your child oversteps the boundaries? What are the sanctions or consequences?
Describe your child(ren)'s typical sleep schedule
Do you have meals together as a family? Which ones? During the week? On the weekends?
Are you strict about table manners?
Are you generally strict about behavior in the house?
Do you supervise your children's homework? Music practice?
Are you in regular contact with their teachers?
Do your children have access to a computer at home? Where is it located in the house? Is access to the internet monitored?
In their room, your child has... (select all that apply)
- Television
- Desktop Computer
- Laptop
- Tablet
Does your child have a cell phone?
Are there time limits on use of electronics? About how much time does your child spend in front of the screen per day?
Do the children often eat snacks and desserts?
Do you give your child a regular allowance?
If yes, how much per week?
Does your child enjoy being part of a group? Do they respect others and their possessions?
Do you allow your child to travel alone?
If yes, explain:
Do you know your child's friends well?
Is your child allowed to drink alcohol or smoke? Are they allowed to spend time with friends who do?
How often do your children see their grandparents?
Describe an 'ordinary' family day:
What household chores do you expect your children to do (making beds, washing up, cleaning, etc.)? What would you expect of the exchange child?
How much freedom will you give the exchange youngster (going out in the evening, time to be home, etc.)?
What sort of family outings and activities would you plan to do while hosting?
How would you describe a good exchange family for your child?

Application NA 2.2.2

2.2.2 (Family and Home Life)

Step 1 of 6 - Parent

How well do you speak (don't be modest):

How well do you speak (don't be modest):

Sibling #1

Sibling #2

Sibling #3

Sibling #4

Other Siblings

The Family Home

Daily Life