Host Family Application

Thank you for participating in our Host Family program.  Your host family application is pending until the ecclesiastical endorsement and if new, W9 and vendor forms are submitted.  We will then review your application and notify you when you are approved to be a host family.  Please understand that we do not guarantee your stated preferences and receiving an assscheduled as a host family.

If you have any questions, please contact  Educational Outreach  at (808) 675-3787.  Mahalo!

Enter GE License Number starting with WXXXXXXXX-01.
Please enter your legal first name (no nicknames or abbreviated names).
If none, please enter "N/A"
Please enter the house number, street, city, and zip code.
Enter PO Box number, city, postal code)
Please select the option that represents your main employment.
Select the option the represents your main employment status.
Enter First and Last Name of Spouse
1st entry is applicant's occupation, 2nd entry is for spouse
Select the primary language spoken in the home.
Select the primary language spoken in the home.
Program requires each guest(s) to have their own bed. Student(s) are not allowed to share futons, double, queen, or king size beds. Private = student has his own room. Shared = 2-4 students share the room not a bed.
Program requires each guest(s) to have their own bed irregardless if the bed is a queen or king size. If a family wishes to host 4 guests, the family must have 4 separate beds to qualify to host 4.
e.g. Monday, January 6, 2013 at 10:00 am Please give Day and Date of preferred inspection time. Hours for inspection are done between 8 am to 5 pm. If you hosted in 2015, you have completed the home inspection.
1. As a Host Family you agree to do all you reasonably can to ensure the safety of your ESL students. Host families are responsible for the well-being of each ESL student (i.e. safety, emotional health, fiscal, etc.). Host families are also responsible in contacting the ESL Coordinator and local authorities (HPD, Hospital, etc.) for all incidents related to the safety of the student. 2. As a Host Family you agree to supply your homestay students with a clean bedroom, their own bed, and all necessary linens and towels. (ESL students may share a bedroom with your child/children but not a bed.) Students should be made comfortable and have freedom to use the home and not be confined to a room. 3. Laundry facilities will be provided by the Host Family. You may choose to do the laundry for the ESL students or decide whether the ESL students will do their own laundry. Please remember that most of the ESL students do not know how to use a washer and dryer. Please take the time to teach them. 4. The ESL students will be provided with three nutritious meals each day, as required (please refer to the program itinerary). EO will provide lunch for the ESL students during the week and when an all-day excursion is scheduled. The Host Family will provide breakfast and dinner (please refer to the program itinerary). 5. The Host Family will provide transportation to and from school. Please be punctual to drop off and pick up your ESL students on time. Do not allow your ESL students to walk home alone after dark. You may choose to arrange a car pool with other host families. 6. Plan to spend time with your ESL students, include them in your family activities and conversations and, if possible, take them on a special outing. Make their stay in the United States a memorable one. 7. Host Families should plan to attend orientation, receptions, award ceremonies, and any ESL Program-sponsored dinner or activity to which they are invited or required to attend. These are important times when all host families and homestay ESL students can enjoy time together. 8. If you are not in the home, do not allow your ESL student’s to stay in your home overnight by themselves. ESL students are not to be left home alone or with a minor. If you are going to be away overnight and the ESL student is not going with you, please contact JJ Huang (808) 393-1469. 9. Host Families agree not to allow visiting guests to stay overnight while hosting ESL students at any time. 10. Host families should not ask your ESL student(s) to babysit for you! 11. ESL students are invited and encouraged to attend church services with the family. No pressure is to be exerted upon ESL students to convert to the religion of the host family, but ESL students are expected to respect the moral standards and religious practices of the family. ESL students who attend church should be encouraged to bring a notepad and make lists of new words they hear each week, to read words and follow along in the hymns, or to take notes. If questions or concerns arise regarding church attendance, please contact the Program Coordinator. 12. Host families are responsible for any illegal actions performed against the ESL student. In the event there is questionable behavior on the part of a family member, the ESL student will be removed from the Host Family immediately. Host families should immediately notify JJ Huang at (808) 393-1469 if any problem or emergency arises and local authorities if applicable. 13. If you have any concerns or problems, you are to contact the JJ Huang. Please understand that an ESL student may request a change of homestay family and that the family may request an ESL student to be changed if, after sufficient time has elapsed, they find they are not compatible. 14. The Host Family will receive compensation per ESL student per day. JJ Huang will inform you of the date and arrangements for you to receive your compensation. Payment or fees should not be a topic of discussion with the ESL student. I agree to be fully bound by the terms and conditions of participation in the ESL Host Family Program as outlined in this agreement.
HOST FAMILIES ARE REQUIRED TO FOLLOW THE YOUTH PROTECTION POICY. University personnel with reason to believe that child abuse or neglect has occurred or that there exists a substantial risk that child abuse or neglect may occur in the reasonably foreseeable future, shall immediately report the matter orally to the Department of Human Services, Social Services Division, Child Welfare Services or to the police department. To Report Child Abuse or Neglect ~ from Oahu call 808-832-5300 from a Neighbor Island call 1-800-494-3991 1. A written report must follow the oral report “as soon as possible.” 2. Additionally, if the reporter “is a member of the staff of any public or private school, agency, or institution” the person must notify the person in charge or a “designated delegate”( Security) of the report that was made. 3. The Department of Social Services social worker will collect as much of the following information as possible: - Name and address of the child victim and his or her parents or other persons responsible for his or her care; - Child’s birthdate or age; - Names and ages of other persons who live with the child and their relationship to the child if known; Nature and extend of the child’s abuse or neglect (including any evidence of indication of previous abuse or neglect); - Date, time, and location of incident; - Child’s current location and condition; - Identity of the alleged perpetrator; - Whereabouts of the alleged perpetrator and any history if available; - And any other information that may be helpful in determining the cause of abuse or neglect and whether or not there is a family member who can protect the child.” 4. Minimum Standards of Conduct All BYUH faculty, staff, students or volunteers who are involved in university sponsored programs that involve minors are required to adhere to the following standards of conduct. - Adults should avoid one-on-one contact with minors; where possible, two responsible adults should be present at any activity with minor participants. - Adults involved with minors must adhere to the CES Honor Code in regard to their conduct toward minors. - Adults shall not engage in abusive conduct of any kind toward, or in the presence of, a minor, including sexual exploitation, sexual abuse, hazing, initiations, bullying in any form, or other demeaning activities. - Adults shall not strike, hit, administer corporal punishment to, or touch any minor in an abusive or illegal manner. - Adults shall not maintain inappropriate electronic contact with minors via texting, email, online forums, social networking sites (e.g.,, etc. - Adults shall not assist minors in accessing pornography or make any form of pornography available to them. - Adults shall not transport minors in their personal vehicles unless they are relatives of the minor. Transportation in university vehicles during a university-sponsored program is permitted if two responsible adults are present in the vehicle at all times. - In an institutional setting where students have contact with groups of minors or are in settings where privacy is necessary to the interaction (i.e. student teaching, hospital lab experiences, etc.), two-deep adult presence may not be practical. In this case, students should follow the child-contact protocols set for by the institution. - Faculty, students or volunteers who conduct music instruction with minors should leave the window in the practice room unobstructed during that lesson. - Faculty, staff, students or volunteers at BYU-Hawaii should make every effort to provide counseling to students in a confidential setting. Where possible in counseling with minors, however, the door should generally be left ajar or the window in the door should generally be left unobstructed. - Minors shall not participate in overnight programs unless one of the minor’s parents or legal guardians has given consent. The Child Protection Policy (the “Policy”) adopted by Brigham Young University–Hawaii (BYUH) prohibits any type of abuse, sexual abuse, against children (defined as anyone under the age of 18 years of age) and requires all BYUH employees, contractors, volunteers to abide by the provisions of the Policy. In addition, the Policy requires all BYUH employees, contractors, and volunteers to immediately report any abuse or suspected abuse to the Department of Human Services, Social Services Division, Child Welfare Services or to the police department. To Report Child Abuse or Neglect~ from Oahu call 808-832-5300 from a Neighbor Island call 1-800-494-3991 A written report must follow the oral report “as soon as possible.” Additionally, the person must notify Security of the report that was made. By submitting this application, I agree, certify, and acknowledge the following: 1. I have read the above statements regarding the BYUH Youth Protection Policy, which includes a prohibition against child abuse and procedures for reporting suspected or observed child abuse. 2. I have been provided access to the Youth Protection Policy on the BYUH policy website or in written form. 3. I fully understand my obligation under Hawaii State law and BYUH’s Youth Protection Policy to immediately report suspected or observed child abuse of any kind to the nearest law enforcement agency. 4. I agree to abide by the BYUH Youth Protection Policy throughout the duration of my employment, contract, or volunteer relationship with BYUH.
Appropriate for men (Classroom & General Campus Wear) •Slacks, jeans, dress shorts, sweaters, and sport or dress shirts with sleeves. •If worn, neat mustaches which do not extend beyond or below the corners of the mouth. •Neat hairstyles, trimmed above the collar and leaving the ears uncovered. •Clothing which cover the knee. •Clean-shaven appearance, modest sideburns. •Footwear worn in all public places. Men must wear shirts at all times. Appropriate for women (Classroom and General Campus Wear) •Dress, loose-fitting blouses, shirts and sweaters with sleeves. •Modest, neat hairstyles. •Skirts, gaucho, modest pantsuits, jeans and slacks to the waist. Hemline on dresses, skirts, and shorts must cover the knee. •Footwear worn in all public places. Appropriate Work-out or Athletic Attire •Swim suits are modest in fabric, fit and style (no bikini, two-piece or French-cut styles) •Modest shorts, sweats, and appropriate gym clothing. •Modest t-shirts which cover the back, midriff and arms. •Appropriate footwear in all athletic areas. Inappropriate for men (Classroom & General Campus Wear) •Any sleeveless clothing and clothing that exposes the underarm and waistline. •Any athletic shorts, sweats, or surf shorts. •Earrings or excessive jewelry. •Beards or noticeable (grubby) facial hair. •Body piercing. •Visible tattoos. •Hats, caps, or beanies indoors. •Bandanas. Inappropriate for women (Classroom & General Campus Wear) •Dresses or skirts with lists above the knee. •Tight clothing and leggings. •The no-bra look. •Any sleeveless clothing or clothing that exposes the underarm and midriff. •Evening or formal wear with low-cut necklines, or gowns that are backless, strapless, or which have spaghetti straps. •Any athletic shorts and sweats. •Excessive hairstyles or colors. •Excessive ear-piercing (not more than one pair on lower earlobes) •Body piercing. •Visible tattoos.
I, the applicant, recognizing the hazards and dangers inherent of said activity(s) and/or in the transportation to and from such said activity(s) and already knowing or having been advised of said dangers and fully acknowledging the risk of injury or health inherent therein, whether by my own actions, the actions of others or events beyond my control, do hereby agree to knowingly and voluntarily assume, full responsibility for all of the risks surrounding my participation in said activity(s) and any other activity(s) undertaken as an adjunct thereto, and all risks associated with my own health problems and physical or emotional limitations; I also certify that I am covered by my own health insurance; and, furthermore, for myself, my heirs, and personal representative(s), I hereby fully release Brigham Young University–Hawaii and all its officers, employees and agents, without any limitation or qualification, as to any and all liabilities, claims, demands and actions which might be made by me or my state on account of any losses, expenses or damages of any kind concerning property or personal injuries (physical or emotional) or death which may result, directly or indirectly, from my participation in the aforesaid activity(s), unless any such damages or injury is primarily the direct result of a negligent act or omission by Brigham Young University–Hawaii or any of its officers, employees or lawful agents and not caused in part by my own negligence.
Inspection Date: __________________ Completed by: __________________ Approval Date: __________________