HostFamily Standardized Forms

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These forms have been approved for use in the audit of ESSEX student.    These FORM should be used and maintained in this order for each ESSEX Host Family.  Records must be maintained for 3 years.   

Of note,  As per the Department of State Regulations.....Host Families cannot receive compensation for hosting a student.

			Document	Form	Date		Notes
			ESSEX Host Family Index	HF99	Jan 2011
Audit #			Host Family Forms
1			DOS HF Welcome Letter	DOS	May 2012		Copy  must given to Host Family
2			Host Family Tracking Form	HF201	Jan 2012		Club YEO to track host family visits, one per family
3			Host Family Interview Form (Writable PDF)   Host Family Interview Form (word doc)	HF213     HF213	Aug 2012		Club YEO to confirm Host Family in-home interview
4			Personal Information - Host Family	HF317	Feb 2011		One Personal Information/reference form per background check.   Two references MUST be verified.
5			Host Family Reference Form	HF209	May 2011		Use this form to secure references.  Can be done via US Mail,  telephone or email but MUST document discussion and must be DATED.  References cannot be a relative, only 1 Rotarian is allowed and Counselor/YEO cannot be the reference for the host family.
6			Host Family Application	HF205	April 2011		One per family, to be completed at time of initial interview
7			Student Protection Waiver	YE321	Oct 2012		Each family member 18+ of age must complete waiver for background check.   All background checks MUST be done ANNUALLY          Must document and file for audit all Host family email confirmation of clearance.
8			Host Family Orientation	HF217	Jan 2011		Each family must attend (all family members) Host Family Orientation prior to the student placement and you MUST document and date.
	Section One:  Topics to Discuss						Visit www.exchangestudent.org to download "Host Family Training"  Power point presentation / you can adapt to your District or Club
	Supply the family with Handbook that includes all the information required on the Host Family Orientation Form HF217						Suggested References are : - RI "Primer for Host Families" download or purchase booklet from http://www.rotary.org/RIdocuments/en_pdf/749en.pdf - "Host Family Survival Kit Book" available at Intercultural Press: 617-523-3801
	CISI-Bolduc Information Insurance coverage and claim procedures						http://www.culturalinsurance.com/rotary/rotary_medical_forms.asp or CLICK HERE for procedures/form
	ESSEX program brochure/ Contact Carl Hill for supply ESSEX Inbound Rules and Guidelines  (IB ESSEX Independent Travel Guidelines  (YE325)
	First Night Questions						visit www.rotary.org to download interactive first night questions in English and several languages
	Culture Shock/Intercultural Communications/Cross Cultural Interactions
	ESSEX Student Protection Policy  (SX713) ESSEX Criminal Background Check Policy (SX717) ESSEX Reporting Guidelines- Appendex B (SX714) ESSEX Allegations Reporting Flow Chair (SX716) ESSEX Student Protection Brochure  (SX715)
	DOS Toll Free Number      1-866-283-9090 DOS HF Welcome letter 3/2013 DOS HF Welcome Brochure (9/2011)  (SX725) Dept of State Regulations 22 CFR, Part 62 10/27/2010 (SX701)
9		Training Roster		YE301		Jan 2011	For use with group training sessions, ie Club, YEO, counselors
10		Unforeseen Host Family Change		HF221		Jan 2011	To document unforeseen changes of host family
11		Post Host Family evaluation		HF225		Jan 2011	One for each host family.  To be completed at the end of the placement in the home and filed in the students file.