2019 LIYLS Host Family Application-- Dominion High School
Dominion will be hosting 38 international delegates as part of the 2019 Loudoun International Youth Leadership Summit.  Please read the document "Host Family Information" and complete this form if your family is interested in hosting.
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Student Name *
Student Grade *
Student Cell # *
Student e-mail *
Siblings name(s) and age(s) *
Parent(s) name(s) *
Parent Cell # *
Parent Work #
Parent E-mail *
Home Phone #
Address *
We generally try to pair students with a student of their same gender.  Generally, we have more girl hosts than girl delegates.  If necessary, would your family be OK hosting a student of the opposite gender. *
Will you be able to host for the duration of the exchange?  If no, please explain.  **Note that the fine arts trip to New York is the weekend the delegates arrive, if you are planning to attend this trip, we will try and place your delegate with another hosting student for the first weekend** *
Would you consider hosting two students, if necessary?   *
Do you have any pets?  If so, please describe *
Do you study a world language?   *
Are there any special dietary restrictions in your household?  If yes, please explain. *
Do you feel your personality/lifestyle would better suit itself to hosting an introvert or extrovert?
Introvert-- I would rather host a student that prefers some downtime/alone time
Extrovert-- I would rather host someone who is extremely outgoing and wants to see and do as much as possible
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Is there anything else we should take into consideration when placing a student with your family? *
Please confirm that both parent and student have discussed this opportunity and are prepared to serve as a host parent and host sibling for the 10 days of the summit. *
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