Au Pair International Area Director Reimbursement Form Type of Match:

Au pair
Your Name: New**
Date submitted: Rematch*
E-mail: New**
Rematch*
Send in e-mail attachment to: ginafudd@aupairint.com Extending 6 m w/ same host family
Extending 9 m w/ same host family
Extending 12 m w/ same host family
Instructions: write each host family/au pair per line. Add and delete lines as needed. *Rematch = au pair or host family switching replacing in the middle
**New = au pair's first placement and host family starting a new prog

Arrival Reimbursement:
In-Home Meeting Date of Arrival
Host Family Name Au Pair Name Date of Arrival to Date of Welcome Call
Date Meeting"
Host Family or
Date of Extension
Contact AP&HF within 48 In-person meeting w/ AP&
NA for rematch,
Start hours of arrival. HF within 2 weeks of
extension or done by NA for arrival.
(Last, First) other AD (Last, First) extensions NA for extensions

Departure Reimbursement: Please to attach your updated contact log for the au pairs leaving your cluster.
Complete Log
Host Family Name Arrival Au Pair Name Departure Date Months Served
Enclosed
 Re-match or Early
Return: last official date X (month #Y - #Z)
Date or month of Number of Months
with Host Family.
(Last, First) Arrival in the US or (Last, First) Completed: date or
MM.YY To MM.YY and Month Number
of Extension month Arrival Month = 1
Other: NA st.

Recruitment Bonus and Other:

Is the Family in
Host Family Recruited by You** State Has Au Pair Arrived?*** Describe How/Where Host Family Was Recruited
Your Cluster?

(Last, First) Yes, No Yes, No e.g. Craig's list ad, magazine ad, friend, web/interest form, etc.

** AD receive a $100 recruiting bonuses per host family directly recruited by you, inlcuding leads from interest forms/company website.
Referral bonuses by current host families are awarded to the family in the form of a credit towards future program fees and not to the AD.
** *Recruitment bonuses are paid after the au pair has arrived at the host family's home.
 Type of Match: Arrival
Host family reimbursement
New** $250
New** $175
Rematch* $125
Rematch* $125
ng 6 m w/ same host family $125
ng 9 m w/ same host family $125
ng 12 m w/ same host family $250
h = au pair or host family switching replacing in the middle of their program year.
au pair's first placement and host family starting a new program year (including renewal)

Type of Match* AP/HF Reimbursement Edits Notes

>New AP/New HF
>New AP/Remathc HF
>Rematch AP/New HF
>Rematch AP/Rematch HF
>Extending (6, 9 or 12 m) Office use only Office use only

Sub total $0

Au Pair Program Status Reimbursement Edits Notes

 >Extension
>Completed 1st year
>Completed 6, 9, 12 m ext. $250 per 12 months
Office use only Office use only
or $20.83/month
>Rematch
>Early Return

Sub total $0

Host Family Was Recruited Bonus Edits Notes

e ad, friend, web/interest form, etc. Office use only Office use only

Sub total $0

TOTAL $0