Host Family Interview Report

YEO Host Family Interview Report

Your Name *

Your Email *

Student to be placed (Full Name) *

Student's Home Country *

Family Member First Name *

Family Member Last Name *

Date of Interview and Home Visit *

Address 1 *

Address 2

City *

State *

Zip *

Reviewed and comfortable with family's demographic responses *

Yes

No

Reviewed and comfortable with family's dietary answers *

Yes

No

Reviewed and comfortable with family's school answers *

Yes

No

Reviewed and comfortable with family's home environment answers *

Yes

No

Reviewed and comfortable with family's informational answers *

Yes

No

Reviewed and comfortable with family's activity level answers *

Yes

No

Reviewed and comfortable with family's community description answers *

Yes

No

The photos submitted by the family match the home visit experience *

Yes

No

High School student will attend *

School Official's Name

School Official's Phone

School Official's Email

Size of Student Body *

Distance of School from Host Family Home *

SMS/MMS