Bookmark and Share
Student Application for Homestay

If you would like to stay in the home of an American family during your studies at Agape, please complete this online form and submit it to Agape at least 4 weeks prior to your arrival in the United States.

1. Location of Program
I would like to join the program in


2. Personal Information
Given (First) Name*
Family (Last) Name*
Other Name
Address*
City*
State/Province
Country*
Zip/Postal Code
Phone*
Fax Number
E-mail*
Gender*


Date of Birth* (MM/DD/YYYY)
Country of Birth*
Country of Citizenship*

3. Emergency Contact

Person to contact in case of an emergency.
Name
Address
City
State/Province
Zip/Postal Code
Business Phone
Home Number
Email
Relationship to You

4. Personal History

Please answer the following questions. NOTE: All information is confidential.
Do you have any health conditions or allergies?

If yes, please explain.
Do you smoke?
Do you use alcohol?
Do you use narcotics?
Have you ever been seen by a psychologist, psychiatrist, or professional counselor?

If yes, please explain.
Have you ever been convicted of a criminal offense?

If yes, please explain.
Are there any foods you cannot eat?

If yes, please explain.
Are there any foods you dislike?

If yes, please explain.
Are you willing to live in a home that has a pet (for example, a cat or dog)?
Please list your hobbies and interests:
What are your expectations of an American host family?

5. Rules for Students Living with American Families

Your Responsibilities

  • You may arrive the week before your English program begins, and must leave the host family the Saturday after the program ends unless prior approval is given by both the host family and the Director of Agape.

    You must pay all of your homestay fee before you arrive in South Carolina to begin your homestay. You may pay by bank draft, money order, or wire transfer. Be sure that Agape receives your homestay fee before you arrive in South Carolina
  • Students living in an American home must follow family rules. Each family will have different rules. Improper behavior toward your host family will not be tolerated.
  • Students must respect the host family's property. Students who damage the host family's property must pay for the damages.
  • Cigarette smoking (inside the house), alcoholic beverages, and/or illegal drugs are not allowed at any time.
  • The student is responsible for any long distance telephone calls. You should call collect or use a private calling card. If this is not possible, your family may require a deposit for use of their phone for long distance calls. Please note that use of the telephone is at the discretion of the family.

NOTE: Violation of any of the above rules will result in the student's removal from the host family without a refund (in severe cases), or in a verbal or written warning. Continued improper behavior by a student on warning will result in expulsion from the homestay and Agape without a refund.

Other Guidelines

Transportation for shopping or for other reasons is at the discretion of the family. Please notify the director of Agape if you are having difficulty locating transportation for necessary local travel.

Your host family is not responsible for providing your personal items (e.g., tissue paper, shampoo, toothpaste, and other toiletries).

You are responsible for keeping your room neat, and for helping keep the house neat when you use an area other than your room.

Visitors are allowed only at the discretion of the family.

Please let your family know your plans when you are not at home. Please do not disturb them when you come in late.

The Host Family's Responsibilities

Your host family will provide breakfast and dinner on class days, and lunch on days when there is no class. You should make arrangements for your own lunch.

Your host family will do the general house cleaning.

NOTE: Agape understands that the American way of life may be different from yours. Please make an effort to discuss things with your host family. Agape host families care about their students. Please try to accept their invitations to participate in family life.

I have read and understand the Homestay Fees and the Homestay Refund Policy. I also understand that the application fee and any transfer fees are non-refundable.

6. Submit Application!

Please press only once and be patient! Thanks!