HostFamily Standardized Forms

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These forms have been approved for use in the audit of student materials.  Forms below identified with ** should be used and maintained in this order for each ESSEX Inbound Student.     Records must be maintained for 3 years.   

To download a form please CLICK the Form Number or document as indicated.

Download the Host Family (section 2) "BLUE BOOK" 2010 - necessary documents to meet the audit process.

Document	Form	Date	Notes
ESSEX Host Family Index	IB299	08/14/09	Printable list of forms below
Host Family Forms
**  Host Family Tracking Form	HF201	02/15/09	Club YEO to track host family visits, one per family
**  Host Family Application	HF205	08/14/09	One per family, to be completed at time of initial interview
**  Student Protection Policy Appendix A   "Personal Information"	YE317	11/11/09	Each family members 18+ of age must complete
** Student Abuse Waiver	YE321	03/21/10	Each family member 18+ of age must complete waiver for background check
**  Host Reference Form	HF209	11/11/09	Must check, at least, two references per background check
**  Host Family Interview Form	HF213	11/11/09	Club YEO to confirm Host Family in-home interview
**  Host Family Orientation	HF217	02/15/09	District or Club to confirm that the Host Family attended an Orientation
Section One:  Topics to Discuss			Click Here to view "Host Family Training"  Power point presentation / you can adapt to your District or Club
Supply the family with resource book or booklet on Host Family Survival			Suggestions 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; Intercultural Press:     617-523-3801
CISI-Bolduc Information                                       Insurance coverage and claim procedures			http://www.culturalinsurance.com/rotary/rotary_medical_forms.asp
ESSEX program brochure/ Contact Carl Hill for supply ESSEX Rules and Guidelines ESSEX Independent Travel Guidelines			Click the document to view
First Night Questions			Click the document to view -    to translate questions in other languages go to www.rotary.org (search for 1st night questions)
Culture Shock/Intercultural Communications/Cross Cultural Interactions			Click the document to view:  other similar documents on Culture Differences can be viewed on:  www.yeoresources.org
ESSEX Student Protection Policy ESSEX Student Protection Brochure			Click the document to view
DOS Welcome Letter  DOS Toll Free Number Flyer DOS Welcome Brochure			Click the document to view
** Training Roster	YE301	02/15/09	For use with group training sessions, ie Club, YEO, counselors
** Unforeseen Host Family Change	HF221	02/15/09	To document unforeseen changes of host family
** Post Host Family evaluation	HF225	02/15/09	One for each host family