Reference Form

Host Family Reference Form

Thank you very much for taking the time to complete this reference form! Your honest feedback is an important part of our host family selection process. Of course, your answers will be treated confidentially. If you prefer giving your reference over the phone, you can reach us at 503.274.1776 and at 800.274.6007.

Please tell us about the family that applied to host:


			Please fill in your first and last name:



	What is the name of the family you are giving a reference for?



	How long have you known the family?



	What is your relationship to them?


	Would you feel comfortable if you or your child were to spend a month with them?


	Yes.

	No.


	Are you aware of any alcohol or drug problems in the family?


	Yes.

	No.


	Is there any reason why you would hesitate to recommend this family for hosting?


	On a scale of 1 to 5, 5 being excellent, what is your opinion of the following:


	The family’s closeness, warmth, and stability:

	IThe family’s interests and activities:

	The cleanliness of the family’s home:


	Is there anything else you think we should know about this family?

Your own cross-cultural experience:


	Would you like to receive information about ANDEO’s hosting programs in the Pacific Northwest?


	Yes.

	No.


	Would you like to learn more about ANDEO’s homestay programs abroad?


	Yes.

		No.


	If you requested any information from ANDEO, please fill in your contact information below. We can email you, send you the information by mail, or give you a call, whichever you prefer.