2010 Summer Program Host Family Application Form

On behalf of the State of Ohio, the Ohio Department of Development, The University of Shizuoka, and the government of Saitama, Japan, the Institute for Japanese Studies at The Ohio State University is pleased to have the opportunity to host several different delegations of Japanese groups.
The groups needing host families either on the weekend or evenings are:

Shizuoka Health Sciences English Program (weekends June)

University students from Shizuoka prefecture

Saitama-Ohio Internship Program (evenings or weekends, July)

Two individuals in the Saitama-Ohio Internship Program

Shizuoka Summer English Program (weekends of August)

University students from Shizuoka prefecture

If you are able to host return this form to the Institute for Japanese Studies at 614-292-3345 and stucky.7@osu.edu

or the Japan-America Society of Central Ohio at 614-292-4002 and jasco@osu.edu.

Personal Information

First Name: *

Last Name: *

Name of Spouse:

Occupation (spouse):

Occupation (you):

Pleast list the names and ages of your children:

Please tell us a bit about you and your family:

Basic Information

Address 1: *

Address 2:

City: *

State: *

Zipcode: *

Phone (primary): * * please include areacode

Phone (alternate):

Email: *

Do you have pets?: *

YES

Specify

What kind?:

Describe your major hobbies and interests: *

I am willing to host for the following time periods: *

Specify

Please specify dates preferred:

Housing

Are there any special rules or observances that your guest should know about regarding your home and family life?: *

Do you or any family member smoke?: *

Would you host someone who smokes?: *

YES

YES, if he/she smokes outside

I prefer the gender of the Japanese persons to be: *

Male

Female

Either

If you indicated an interest in hosting a female visitor

Would you host a male?: *

Would you be willing to host more than one host at a time?: *

Will your guest have his/her own bedroom?: *

Please briefly describe your guest's living space:: *