Homestay Initiation Form

Please fill out this form to begin a new homestay.

Director/Manager

Coordinator (if any)

Date to Start Homestay

YYYY

Student Name

First Name

Last Name

Student Email Address

Student Phone

(###)

###

####

Monthly Homestay Fee

First Month Fee (pro-rated)

(Monthly homestay fee ÷ number of actual days in 1st month x number of days student lives there, including move-in day)

Student pay by credit card?

If the student opts to pay by credit card, we will add 3% fee to the invoice.

Host Name (Primary)

First Name

Last Name

Primary Host Email

(required for background check)

Primary Host Phone

(###)

###

####

Host Name (Secondary)

First Name

Last Name

Secondary Host Email

(required for background check)

Secondary Host Phone

(###)

###

####

Host Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

How Did Host Come To Us?

Monthly Host Stipend

First Month Stipend (pro-rated)

(Use same calculation as above)

Monthly Director/Manager Commission:

First Month Director/Manager Commission:

(Use same calculation as above)

Monthly Coordinator Commission:

(Enter amount if Coordinator selected above)

First Month Coordinator Commission:

(If applicable, use same calculation as above)

Monthly USAH Admin Fee:

($60 unless approved special situation)

First Month USAH Admin Fee:

(Use same calculation as above)

Funds are correct

(Double check that first month's host stipend + director/manager commission + coordinator commission + USAH admin fee = exact amount of first month student homestay fee)

Special Notes

Are there any special circumstances (deposit waived, short-term stay, no food, married couple, etc.) which require a change to the standard contract? If yes, please describe.