Homes for Service
Overview Expectations Sign
Up Sharing
Space Reminders
Sharing Your Space
This worksheet can be printed out for use when you meet with an AmeriCorps member. Be sure to discuss these points (and add your own!) BEFORE you finalize any housing arrangements.
Remember, "Homes for Service" does not conduct any assessment of the Host Home offer or AmeriCorps member. It is up to each party to assess the suitability of the proposed arrangement. Both Hosts and AmeriCorps volunteers are urged to ask for and give names of references. No one is obligated to be a Host or accept the offer.
1. Location of host home (in a neighborhood, on a fire road, on a main road with heavy traffic, etc.):
2. Length of time housing to be provided (one month, three months, up to one year, etc.):
3. Briefly describe the space available (separate apartment or guest house/private room and bath/private room, shared bath/other (please elaborate):
4. Is the host home free or will you charge a nominal fee (we suggest no more than $200 for room in your home; anything over $400 is not considered a Home for Service):
5. Briefly describe all members of the household:
Number of adults and approximate ages:
Number of children and approximate ages:
Number of pets and what species (dogs, cats, snakes, etc.):
6. Briefly describe any special lifestyle issues:
Diet (vegetarian, meat eating, etc.):
Alcohol (do you use it; do you accept those around you using it):
Smoking (do you smoke; do you accept others smoking near you):
Work schedule (does anyone work nights and sleep days? work from home?)
Illness or special medical condition: (diabetes, severe allergies, disability)
Other:
7. Other household issues:
Can the AmeriCorps member bring friends into the home; for how long (evening, overnight, weekend):
Would the AmeriCorps member and host like to share meals occasionally:
Will the AmeriCorps member be able to keep food in the refrigerator or dishes in the kitchen:
What rooms of the house will the AmeriCorps member be able to use:
Will the AmeriCorps member be able to use a radio, television, VCR or CD player in his or her room:
What kind of parking will the AmeriCorps member have - on-street, off-street, other:
Will the AmeriCorps member have laundry privileges:
Will the host home or the AmeriCorps member provide bedding and/or towels:
What does the host home consider as reasonable use of utilities (water, electricity, etc.):
How will telephone use be dealt with? (Separate line? No phone privileges? Cell phone expected?)
8. While doing chores around the house cannot be a requirement of an AmeriCorps member's living arrangement, he or she can be expected to contribute to occasional household chores just as any other inhabitant of the home.
How would the host like the member to contribute to the household (pet care, cleaning, etc.)
How would the AmeriCorps member like to contribute to the household:
9. Three things you want people to know about living with you (medical issues, sleeping habits, strong ideological views, special interests, religious practices, etc.):
A.
B.
C.
10. Additional questions I have about the other person:
A. ________________________________
B. ________________________________
C. ________________________________
11. References. Each party should decide the number of references you need to make your decision. At a minimum,
Members: Provide the contact information for your AmeriCorps program director or VISTA project supervisor so host home may verify your service.
Host homes: Please provide a personal reference that is not a relative.