HOST FAMILY APPLICATION FORM

____________________________________________________________________
Chapter Name State
Bangalore Karnataka

_____________________________________________________________________
School Name Local Volunteer Responsible
Nitte International School for this placement

_______________________________________________________________________
AFS participant name Country of Origin
MEET PATEL India

Please attach 3 recent photographs of your family. Additional

Photos of the family and home are most welcome and will be
seen by the participant. Date and identify all photos with names
Of individuals and home address to insure against loss if
photos get separated.

Picture identification (left to right)

Host family name : SHETTY FAMILY

We are applying to host: A STUDENT: School[ YES], University [ ] A VOLUNTEER

__ For a full year - YES __For a full year
__For a semester __ For a semester
___ as a welcome family __ As a welcome family
___ as a replacement family ___ as a replacement family

Program Starting: 2019 onwards

Month: April Year: 2019

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 HOST FAMILY APPLICATION FORM
Host Family Application Instructions

Congratulations on your decision to host an AFS student from another country. We hope this will be a
richly experience for all of you. Completing the AFS Host family application is an important step. The
information will serve 2 purposes:
1. to help ensure an appropriate placement
2. to introduce your family to your AFS son or daughter, allowing him or her to get a first
impression of what to expect as a member of your family.
We must have a complete application before we can place an AFS student in your home, so please return
all the forms to the AFS National office or your local AFS chapter.
Be sure to keep a copy for your records.

FORMS TO BE COMPLETED BY THE HOST FAMILY:

1. Application cover
2. Form A: Host family Information
3. Form B: Introduction to family & Community
4. Form C: Parent’s statement & reference contact
5. Form F: Host family agreement
6. 2 Host family reference forms – Please give these pages to 2 people who can attest to your
suitability to be an AFS host family.
7. Family photographs- If you would like, please include extra pictures on an additional page, which
will be forwarded to your student.
8.

PLEASE KEEP A COPY OF ALL THE RECORDS SEND.

FORMS TO BE COMPLETED BY AN AFS VOLUNTEER

1. Form D: Host family interview

2. Form E: School information
3. School Placement acceptance form
4. Submit liaison information to National office via mail,email.

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FORM A: HOST FAMILY INFORMAITON

To be filled by the host family. Please type or print in black ink. This form will be shared with the
participant and his/her natural family.

_________________________________________________________________________________
Chapter Family name
Bangalore Chapter Shetty Family
_________________________________________________________________________________
Father’s name Occupation Employer
Padmanabh Shetty Business Not Applicable

__________________________________________________________________________________
Mother’s name Occupation Employer
Sunita Shetty House Wife Not Applicable

Home Address: C301/Affinity Meadows, Ramanashree California Layout, Behind Ramanashree

California Resort, Ananthpura Road, Yelahanka - 560064, Bangalore
__________________________________________________________________________________
Phone Home Mobile Office Fax
Not applicable 9428660530 7405390001 Not Applicable

Email: meetp2711@gmail.com

Family members / others residing in the home

Name Relationship Living at home Birthdates dd/m/y Country of birth
Padmanabh Father Yes 15/04/1965 India
Sunita Mother Yes 10/02/1970 India
Meet Son (Myself) Yes 27/11/2002 India
Aakash Son No 22/11/1996 India
Palak Daughter No 13/03/1990 India

PLACEMENT INFORMATION:

1. Religious affiliation or preference:No preference_____

How often do you attend the services___weekly__monthly__occasionally__never
2. Is your family willing to host__male__female__no preference.
3. will the candidate share a bedroom__yes__No! Will have a private room. If yes with whom:
Not applicable
4. Does anybody in the family smoke__yes__No!
What are your feelings about a participate who smokes? __no problem__okay if
outside__strongly object!
5. Do you have pets__yes__NO. if yes what kind________________. __indoor__outdoor
6. What language is spoken in the home: Hindi, Gujarati & English
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7. Can the family members speak English____YES__________
8. Has your family ever hosted on AFS program:_YES________
If yes
Ne Peruvin: Thailand : 1 Year
Jan Seiving: Germany: 1 Month
Anek: Thailand: 15 days
Indonesia: 15 days

FORM B: INTRODUCTION TO HOST FAMILY & COMMUNITY

To be completed by host family. Please type / print in black ink. This form will be shared with
the participant and his / her natural family.
COMMUNITY / COLONY INFORMATION
1. Name of the colony: Ramanashree California Layout
2. Check the box which describes your area of residence__urban__suburban__small
town__rural area: Residence_ URBAN
3. Closet larger community: Not applicable
4. Describe your community, including social and economic characteristics, ethnic makeup,
availability of public transportation, etc.
Yelahanka is a suburb of Bangalore in the state of Karnataka. Yelahanka lies to the north of Bengaluru. It is
closer to the International Airport of Bangalore.
Yelahanka is surrounded by many lakes and parks. It’s a residential town with around 5 lakh of population.
Within 5 km you have access to the train stations and with 500 mins the nearest bus stop which have network to
all the bus stations.
Food eateries, malls, cafes and shopping stores are accessible in 10 mins
School & Colleges
There are many schools and colleges around Yelahanka. The most famous Srishti Institute of Art, Design &
Technology, one of India's premier art and design institutes, has six campuses across Yelahanka New Town.
The Japanese Weekend School of Bangalore, a Japanese weekend educational programme, serves Japanese
nationals living in Bangalore. It holds its classes in the Canadian International School.[4]
There are many technical education institutions in and around Yelahanka. Some of the prominent engineering
colleges are also present in Yelahanka
Defence Establishments is the pride of Yelahanka!
• The Indian Air Force has a presence in Yelahanka with an Air Force Station and a defence airport
situated on NH7. An international air show is held every two years which attracts manufacturers and
sellers of defence equipment, defence aircraft, and "next gen" fighters.
• The BSF (Border Security Force) has a training center in Yelahanka. The Special Operations Training
center is located on NH7, towards the northern part of the suburb, on the road leading to BIAL.
• CRPF (Central Reserve Police Force) has a training school for their officers and troops at Yelahanka,
with residential campuses for the troops. CRPF campus is located in lush green environment on
Doddaballapur Road.
• Karnataka State Reserve Police has its Training facility at Yelahanka. The academy is located in the
northern part of the suburb, near the Air Force station.
• Geography
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• The summer season lasts from March to mid-May, with temperatures ranging between 23–38 degrees CelsiusAt
the end of May, the monsoon season starts and lasts until the end of October. There are about 45 inches of rain
annually. Yelahanka is served by both South west as well as North east monsoon.Winters are mild and last from
November to February, with temperatures ranging between 13-28 degrees Celsius.

HOME ENVIRONMENT
You may attach a separate sheet of paper with the answer to these questions if you wish.
1. Describe your neighbourhood and home in as much detail as possible, including any recreational
facilities available. Indicate whether the student would have an easy access to club, cyber café,
playground etc:

> There are plenty of food cafes in the town due to big number of schools and colleges present in Yelahanka
Town.
> Internet cafes, Stationary shops are present near each schools in Yelahanka
> There are more than 20 parks in Yelahanka and there are around 5 lakes in the town.
> Our house is located in one of the park itself.
> There are 4 playgrounds near our house. Meet goes to play Basketball & Football which is accessible in 4
km
> For walking, cycling we have many parks

2. Please describe each family member (including yourself) as to personality, interests etc.

Myself Meet, I am studying in 12th grade. My School is about 8 kms from the home and I go to school by bus.
My passionate sports is Basketball and I go out for practise everyday from 06 to 08 PM. Love reading books, love
to explore new technology and innovation side of science.

Sunita, is the mother in the house. She is housewife. Loves cooking food, believes in organic food and the farming.
She keeps trying new Indian dishes at home for me. Loves gardening. Super active throughout the day.

Padmanabh, is the father of the house. Very funny and cool dad to have around. Loves to hang around outside
with the children. For him sports is very day walk of 5-6 km in the evening. Keep himself busy in helping mother
with household chores and vegetable chores is his department. Hahahaha!

Aakash Shetty, Eldest Son in the Family. We hosted lot of students in our house and he was the first one
from our family to go on AFS program. Loved boy of our family. He went to Germany for 1 year
Exchange Program with AFS and now this year he will finish his last semester in Berlin. He is studying with
Karlsruhe Institute in Karlsruhe, Germany.

Palak Shetty, Eldest Daughter in the Family. She is working in Bangalore with Decathlon Sports since last 7
years. But now married and have a house in Thrissur Kerala. So she can work from Thrissur and Bangalore both
the places. She comes to Bangalore every month for her meetings and work. And in a way she is with us as well.

3. Describe a typical weekday in your family?

Our day starts early around 06:00 am, as I got to leave for the school at 08:00. Mother cooks the breakfast and the
lunch both in the morning for me to take in the school.
I come back around 04 Pm and we have together evening snack and we chill out together or go somewhere if we
have to buy something. If not, we all go out for sports. I go for Basketball. Mother Father goes for Walking, or
meeting some friends or neighbours.

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We have dinner around 08 - 09. And we sleep by 10:00 PM!

4. What type of chores do you expect family members to help with around the house?
> Helping in the kitchen
> Cleaning the utensils
> Washing clothes in machine
> Sweeping floors
> Gardening
> Watering Plants
> Organising Cupboards once in while

5. Do you have non-negotiable rules in your household ( such as parties, night out)
> Yes we sleep around 10:00
> We inform our parents about our whereabouts or we have taken them with us.

6. Does any member of your family have a dietary restriction (such as vegetarianism). Please give
details.
> Mother is a Vegetarian and do not cook non vegetarian dishes at home.
> Father, Myself, Brother & Sister we eat non vegetarian. When we go outside to a hotel, we can order non veg.
Or we can order the food at home. But we all love Vegetarian food as well. And we eat Veg at home.

7. Name(s) and year(s) in school of any of your children attending the school.
Meet Patel - NITTE International School - 12th Grade - (Studying in the same school since 09th Grade)

FORM C: Parents’s statement and reference contact

This is to be completed by the host family. This form will not be shared with the participant.

Family information
1. If there have been any recent major changes (separation, divorce, serious illness, death) in your
family. Please describe changes/impact on each family member.
Not Applicable. We all stay together, and have family functions when sister and brother visits us, or
when we go to our home town in Gujarat. It’s a bigger and bigger family :)

2. If you are divorced or separated, please indicate how often the children have contact with the
other household and how this will impact the hosted student.
Not Applicable.

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3. Does the family member or other person living in the home have a serious illness or chronic
condition? ___Yes___No
Has any family member received professional counseling within the past 5 years?__Yes__No
If yes to either above, please attach a brief explanation describing how the situation affects the
family members’ everyday lives, the dates, of the illness / treatment, and if the family member
is currently in stable condition.
Not Applicable.

4. Has any family member or anyone else living in the home ever been convicted of a
crime?__Yes__No. If yes, please attach a brief explanation which gives date, reason for
conviction, and outcome.
Not Applicable.

5. Has any family member ever had his / her driver’s license suspended or revoked?__Yes__No
If yes, please attach a brief explanation which gives date license was revoked, reason.
Not Applicable.

REFERNCE INFORMATION:
I plan to give my personal reference pages to:
Name Name

Address Address

City/state/zip City/state/zip

Phone Phone

Email Email

FORM D: HOST FAMILY INTERVIEW

To be completed by an AFS Volunteer. Please type or print in black ink. This form will not be shared
with the participant nor his / her natural family.

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 HOST FAMILY APPLICATION FORM
__________________________________________________________________________________
Chapter Name of volunteer Date

1. Based on your interview, which of the following attributes do you feel most accurately describe
the family?
- casual home - family centered activities
- sports / outdoor activities - planned / organized home
- intellectual pursuits - decision making role assumed by
- mother-dominant home parents
- much communication - individual pursuits
- active participation in community / - father dominant type
volunteer functions - openness with feelings
- humor - decision making by family consensus
- low key, quiet home - spontaneity
- neatness - other

2. Please provide a general assessment of the home and family environment.

3. Comment on any placement recommendations or restrictions.

4. Which family member initiated the idea of hosting?_____________________________

5. Will any of the members be away from the home during the hosted student’s time in the
home(including vacation at the time of arrival)__yes__no. If yes, explain who, dates away, and
if it affects the hosting.

6. How did the family become interested in hosting?

__school__add __mailing __AFS Chapter __ previous hosting experience __ other
7. Based on the assessment outlined above, does this chapter and / or this writer believe there is
adequate commitment and resources in this family for a successful hosting experience. __ yes
__no
If no please comment:
___________________________________________________________

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FORM E : SCHOOL INFORMATION
To be completed by an AFS volunteer or school official. Please type or print in black ink.
This form will be shared with the participant and his/ her natural family.

Chapter Name of the AFS Faculty Advisor

School Name Principal Name School Phone

School address

School Email id Contact person for exchange program

1. Type of school:
__ Public __ Government __ Boarding __ Private __ only Boys __ only Girls __ Coed
2. Total anticipated number of AFS students hosting for upcoming year __ 1 __ 2 __ more
3. Total students __________ School upto ______ Graduating class size_________
4. First day of class ________ Graduation day ____. Is diploma granted to foreign students___
5. a) Foreign languages taught and number of years offered:

b) Immunization and tests required for enrollment, including dosage. Please attach separate sheet if
there)

6. Briefly describe the school curriculum including any areas on which the school places special
emphasis. Please attach separate sheet if necessary.

7. Describe the social and academic atmosphere of the school including any factors significant
for placement, or which AFS student’s coming to this school should know.

8. Are there any specific enrollment requirements for foreign students and / or limitations on
participation in any athletic or extra curricular activities which are imposed by your school /
board? If so please explain

9. Date by which the student applications must be submitted for approval by school?

10. List or attach minimum entry requirements for exchange students in school.

11. Are there any mandatory fees that student pay to enroll at this school? __ Yes __ No
If Yes please give amount

PLACEMENT ACCEPTANCE FORM

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 HOST FAMILY APPLICATION FORM
To be completed by an AFS volunteer and school official. Placements are not complete and cannot be
confirmed without this document.

Name of the AFS volunteer ___________________________________________

Students Name_________________________________________ Country ________________

Student’s date of graduation in his / her home country. (Month / year) ___________________

Host family’s name_______________________________ Phone No. _____________________

Address
______________________________________________________________________________

____________________________________________________________________________

Local AFS volunteer name __________________________________ Phone No. ______________

Address
______________________________________________________________________________

____________________________________________________________________________

TO BE COMPLETED BY A SCHOOL OFFICIAL

School Name _______________________________________________________________

As designated school official of school mentioned above, I accept this AFS student for the enrollment
for the __________ school year.

Date enrollment approval given ______________________________________

School Official Print Name________________________________ Position ____________________

School Official Signature

Date

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FORM F HOST FAMILY AGR

EEMENT
The purpose of this agreement is to fully inform host family members of their rights and responsibilities as an AFS
host family. Throughout the hosting experience, host parents are urged to call their AFS Liaison with any questions
that arise. The signature on the bottom of the form indicates that an AFS volunteer has explained the contents of
the agreement to you. A copy of this agreement should be kept for your records.

AGREEMENT: HOST FAMILY RIGHTS AND RESPONSIBILITIES

Our family agrees to host an AFS Exchange participant. We have had an interview with an AFS representative.

As a host family we have a right to:

1. Expect the AFS participant to be a full family member inasmuch as it is possible.
2. Be assigned an AFS liaison who will be in regular contact with us and with our participant to monitor
progress.
3. Contact the AFS liaison for help with adjustment issues.
4. Have access to AFS staff through a 24 hour emergency number.

As a host family we agree to:

1. Provide a safe and nurturing environment and treat the participant as a member of our family.
2. Provide the participant with his or her own bed.
3. Provide the participant with meals (including lunches and meals eaten as a family in restaurants).
4. Accept basic everyday expenses incurred by having the participant in our home.
5. Ensure that the participant has transportation to and from school.
6. Ensure that the participant attends and takes full part in AFS activities and orientations during the exchange.
7. Attend orientations and activities held for host families as required.
8. Ensure that our family and our participant have contact with the AFS liaison or other designated AFS
volunteer on at least a monthly basis as required by law and be as flexible as possible in arranging time in
our schedule and that of our participant to meet with or talk with our AFS liaison or other designated AFS
volunteer.
9. Assists our participant in having a successful experience in school, seeking help from the AFS liaison if
the participant is experiencing unusual academic difficulties.
10. Encourage the participant to not communicate with home country friends and family more frequently than
recommended in the AFS-India communication guidelines stated in host family handbook.
11. Abide by guidelines for natural family visits and contact our AFS liaison immediately should a natural family
member propose to visit the participant during the exchange period.
12. Always notify the AFS liaison ( or in the event that the liaison is not available, AFS staff or another volunteer )
in a timely manner for the following reasons:
a. if our family and /or the participant is away from home for more than 24 hours, giving contact details in case
of an emergency.
b. if serious issues arise including but not limited to: serious illness, injury, or hospitalization: arrest or detention
by authorities violation of AFS rules regarding driving, hitchhiking or use of illegal drugs, potentially
harmful behavior.
c. if we learn that our participant has had unexcused absences from school, has missed classes or is having
other academic problems.
d. if we are considering hosting any other exchange participant, even if on a temporary basis, so that the AFS
India staff and the participant’s natural family can be contacted for approval of the double placement.
e. if contact from the natural family ( via phone, letter, or E-mail ) interferes with the participant’s adaptation
process.

As a host family we understand that

1.The AFS Participant Will come with spending money for optional activities or purchases during the exchange
period
2. We are not the legal guardians of the AFS Participant.

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 HOST FAMILY APPLICATION FORM
3. We may sign forms for school- related activities by crossing out the words parent/Guardian; and writing in Host
Family to make the relationship clear.
4. We must obtain the signature of the natural parents or guardians in the participant’s home country for any other
documents requiring natural parent or legal guardian signature.
5. AFS has the sole responsibility for determining host family placements.

FORM F (CONTINUED)

6. AFS will assist our family and our participant in having a successful hosting experience However AFS volunteers
have the authority to move the participant to another family if this is in his or her best interests and /or the interests of
our family.
7. AS part of their selection process the AFS participant and natural parents have agreed to AFS rules and guidelines
regulating participant behavior as outlined in the host family handbook.
8. AFS is an academic program and participants are required to attend school complete assignments and abide by all
school policies.
9. Host families and participants are not authorized to act as agents for AFS for any purpose. 10. AFS does
not carry liability insurance for individual participants or host families and cannot be held responsible for claims for
damages or injuries.
11. AFS participants have a right to legal representation if questioned or detained by police in such a situation we
should contact our local volunteer or AFS staff immediately so that they can assist our participant in arranging for
an attorney .

AS a host family we are aware of the specifics of the AFS participant medical plan as outlined in the host family
Handbook and understand that:
1. The AFS participant is covered by the AFS participant medical plan.
2. Claims should be submitted preferably by the medical service provider directly to global benefits as outlined
in the AFS host family handbook.
3. The AFS participant medical plan does not cover the following:
a. Non-accident-related dental care.
b. routine eye exams glasses or contact lenses.
c. physical (including sports physical ) and immunizations.
d. pre-existing conditions.
4. If the participant requires care as described above that is not covered by the AFS participant medical plan we
will notify the AFS liaison to arrange for natural family consent and payment.
In signing this agreement we understand that it does not constitute either implicitly or explicitly a binding
contractual or personnel agreement please note that we cannot accept electronic signatures.

______________________________________________________________________________
Print first host parent name signature date

______________________________________________________________________________
Print second host parent
name signature date

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HOST FAMILY APPLICATION FORM

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HOST FAMILY / VOLUNTEER REFERENCE FORM

This information on this form will be kept confidential and will not be seen by the host family or
volunteer applicant. You can submit the information by e mail to us at

PERSONAL REFERENCE REGARDING:

This reference is being submitted for __ a host family applicant

__ a volunteer applicant
__ both

AFS Hosting family or volunteer name __________________________________________________

Name of the AFS Chapter (if known) __________________________________________________

Host family or volunteer city and state ___________________________________________________

The above family or individual has applied to host an AFS foreign exchange student or volunteer as a
representative for AFS intercultural program. Please complete the following:

1. How long have you known this applicant and in what capacity?
2. In what ways do you feel this family or individual would be a good host or volunteer for AFS?
3. Do you know any reason why this family or individual should not host a foreign exchange student
or be a volunteer working with international youth exchange?

Name ____________________________________________

Address
____________________________________________________________________________

____________________________________________________________________________

Phone __________________________________

Signature ________________________________

Date ____________________

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 HOST FAMILY APPLICATION FORM

HOST FAMILY / VOLUNTEER REFERENCE FORM

This information on this form will be kept confidential and will not be seen by the host family or
volunteer applicant. You can submit the information by e mail to us at

PERSONAL REFERENCE REGARDING:

This reference is being submitted for __ a host family applicant

__ a volunteer applicant
__ both

AFS Hosting family or volunteer name __________________________________________________

Name of the AFS Chapter (if known) __________________________________________________

Host family or volunteer city and state ___________________________________________________

The above family or individual has applied to host an AFS foreign exchange student or volunteer as a
representative for AFS intercultural program. Please complete the following:

4. How long have you known this applicant and in what capacity?
5. In what ways do you feel this family or individual would be a good host or volunteer for AFS?
6. Do you know any reason why this family or individual should not host a foreign exchange student
or be a volunteer working with international youth exchange?

Name ____________________________________________

Address
____________________________________________________________________________

____________________________________________________________________________

Phone __________________________________

Signature ________________________________

Date ____________________

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