1

    Part 1

    2

    Part 2

    3

    Part 3

    4

    Part 4

    5

    Part 5

    Part 1: GENERAL INFORMATION


    Part 2: RESIDENCE INFORMATION
    Are there any children under the age of 18 in the home? Yes/No

    Other Adults at Home

    Please describe how to reach your home from College of the Canyons

    How long have you lived in the Santa Clarita area (years/months)?

    Do you have any pets living with you?

    Do you own any firearms?

    Do you have a valid driver's license?

    Do you have current car insurance?

    Do you have current homeowner’s or renter’s insurance?

    Does anyone in your household...
    Smoke?

    Consume alcohol?

    Please describe the room where hosted youth will stay

    Part 3: REFERENCES
    Please list three non-relative references who have known you for 2 years or more and can describe your personal and professional capacity to be a good host. Please include at least one reference from past employment or volunteer opportunities.

    Reference 1

    Reference 2

    Reference 3


    Part 4: MATCHING
    The following information will help us in matching you with a guest.

    Why are you interested in being a Host Home?

    What would be the ideal characteristics of a youth you’d wish to host?

    What characteristics of a youth would you NOT wish to host?

    Please tell us about your strengths, experiences, skills or relevant things about you that you would like to share.

    Please describe any background you may have with dealing with youth who’ve experienced trauma / foster care

    What languages are spoken in your home?

    Do you practice a particular faith in your home? Please describe.

    Please indicate how comfortable you are hosting a guest who:
    (Choose from a scale of 1 (not comfortable ) to 4 (very comfortable).

    is the same race/ethnicity as you?

    is NOT the same race/ethnicity as you?

    is multiracial?

    shares your religious beliefs

    does not share your religious beliefs

    has different views on gender identity than you?

    has different views on sexual orientation than you?

    has a physical disability?

    has a cognitive disability?

    has a mental health issue?

    smokes?

    uses alcohol?


    Part 5: ACKNOWLEDGEMENTS

    I understand that all Host Homes applicants will be required to comply with and successfully complete the following checks and screenings during the onboarding process.

    - Home safety check
    - Background check
    - Reference check
    - Covid screening
    - Proof of homeowner’s or renter’s insurance

    I understand that these checks and screenings are required.

    _________________________________

    Part 6: POLICIES

    There are a number of policies that Host Homes participants must agree to in order to be accepted and matched with their guest. Please click on each link below to review the policy and indicate your agreement electronically.

    I acknowledge and accept the Waiver of Liability.
    You can access the Waiver of Liability by clicking on the URL below. You'll be brought to a new browser window, can click on the policy you wish to review and return here to acknowledge your agreement and continue your registration.

    I acknowledge and accept the Host Home Provider Conduct Policy.
    You can access the Host Home Provider Conduct Policy by clicking on the URL below. You'll be brought to a new browser window, can click on the policy you wish to review, and return here to acknowledge your agreement and continue your registration.

    I acknowledge and accept the Photo Waiver.
    You can access the Photo Waiver by clicking on the URL below. You'll be brought to a new browser window, can click on the policy you wish to review, and return here to acknowledge your agreement and continue your registration.