Host Families Reference Form

In order to ensure that the reference you are submitting is accepted, please include the Host Family ID# of the family you are providing a reference for.

If the reference form is complete please hit the 'Submit' button below. If there are required fields that are empty you will be asked to return to the form and provide more information. Please note that the submission must include the Host Family ID# for the family you are referring. You may contact the family to obtain that information.

You will receive a confirmation email at the address you provided above. Please keep it for your records. If you do not receive an email within 48 hours please contact us.

Thank you again for your reference.

Applicant Information
Host Family ID#*
Host Family Last Name
Host Family First Name
Host Family Address
Host Family City
State
Host Family Zip Code
Reference Information
Your Last Name*
Your First Name*
Your Address*
Your City*
State*
Your Zip Code*
Your Telephone*
Your E-mail*
How long have you known this family (in years)?*
Please describe the capacity in which you know them:*
Have you visited the applicant family in their home?*	Yes No
If yes, please describe frequency
Please give us your impression of the family. Include your observations of the relationship of the parents to each other, to the child(ren), and vice versa:*
Please describe any unusual conditions including physical or emotional handicaps or disorders that the child(ren) or parents may have:*
Are you aware of any alcoholism, drug abuse, domestic violence, sexual abuse or other problems in the family?*	Yes No
If yes, please explain:
Are you aware of any history of arrest or criminal charges involving any family member?*	Yes No
If yes, please explain:
Do you believe that the applicant's family would provide a healthy, pleasant homestay experience for a young person from a foreign country?*	Yes No
If no, please explain:
Please feel free to make any further comments or observations which you feel would help us to better evaluate the applicants' suitability for hosting an au pair.

You will receive a confirmation email at the address you provided above. Please keep it for your records. If you do not receive an email within 48 hours please contact us.

Thank you again for your reference.

Host Families Reference Form

Applicant Information

Reference Information

TV News Story on Au Pair Care