Host Application

1 Host Application
2 Host Agreement

  • APPLICATION DEADLINE IS DECEMBER 15

    The Lakota YouthStay program offers an opportunity for Native American youth on the Pine Ridge reservation in South Dakota and residents in the greater Boston area to share their lives with each other in the spirit of friendship and cultural exchange. The success of the experience depends on the commitment of the participants to build relationships, maintain flexibility, work through unexpected challenges, and promote learning and understanding with someone from a background different from their own.

    Lakota YouthStay 2022 will be from July 12 to July 21, 2022.

    We are requesting the information below to help us select hosts who will be able to participate in the program successfully. This information will help us make the optimal matches between hosts and Lakota youth. Only one application and agreement is needed for each household.

    After you submit your application, you will receive an email with a link to pay an initial $25 application fee online. Your application will be considered complete only after the initial fee has been received.

    An on-site home visit at a mutually agreed upon time will be required for Lakota YouthStay hosts once their application is accepted. The home visit and an initial CORI check are essential steps of the application process. Final approval as a host family is confirmed upon completion of the background check in March. We appreciate your interest in the Lakota YouthStay program!

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  • NameAgeGenderRelationship to YouOccupation (previous job if retired) 
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  • If possible, please consider hosting 2 young people in your home. This would greatly increase the comfort level for the youth
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  • The undersigned head(s) of Household agrees to participate in the Lakota YouthStay program by serving as a Host for a Lakota youth. I understand that the Lakota YouthStay is a program of  the West Medford Community Center which includes its officers, directors, employees, and the volunteer workers associated with the YouthStay program. I understand that there are certain risks of having people visit me and stay in my home, and I am willing to assume and bear any and all of these risks in order to meet and share experiences with a Native American youth from the Pine Ridge reservation in South Dakota. Therefore, in consideration of my selection by the Lakota YouthStay as a host for the exchange program, I do hereby release, indemnify and hold harmless West Medford Community Center employees, officers, directors and volunteers from all claims, actions, and causes of action based upon or by reason of any loss, damage or injury to any person or property of any member of the household, arising out of, or in any manner connected with, any aspect of the YouthStay program. As a host, I shall:

    1. agree to a home visit prior to acceptance as a host;
    2. agree to background checks for every adult (over 18 years of age) in the household prior to final acceptance as a host;
    3. provide the same care, support and comfort for the Lakota youth as I would any member of my family for the specified days and nights; including but not limited to room, board, and local transportation (to and from airport and local program meeting sites).
    4. provide an opportunity for a Lakota youth to participate in daily lives and events of the members of my family;
    5. ensure the youth are available to participate in all group activities planned by the YouthStay program for the duration of the stay;
    6. commit to volunteer as a chaperone one full day during the YouthStay week;
    7. participate in all official functions that are planned for hosts during the exchange program;
    8. attend training workshops and an interview, if requested;
    9. attend host family orientation prior to arrival of Lakota youth;
    10. participate in post-trip survey to ensure continuous improvement of program;
    11. accept that the exchange is a public event and that the photographs and names of the Hosts and Host family members may be used by the local, regional, national and tribal media as well as Sanctuary UCC in their publications;
    12. willingly accept in my home people who will be of another race, culture, and/or spiritual or religious preference and who have customs with which I may be unfamiliar.
    Host Pledge:

    I agree to be an ambassador of goodwill to the visitors I am hosting, knowing that the customs, habits and culture of those visitors may be different from my own. The purpose of this exchange is to build sustainable relationships with Native Americans and engage in an intercultural exchange.

    I agree to pay the Lakota YouthStay program an initial non-refundable application fee of $25 for the household.  If my application is accepted upon review by the Program Director and/or Advisory Committee, I agree to pay the non-refundable application fee balance of $100 per adult household member* which covers the criminal/background check, home visit and other administrative costs associated with being a YouthStay host family.

  • I have read the Host Agreement and accept its terms. I certify that I am 21 years of age or older and that the information in this application is true to the best of my knowledge. I give the Lakota YouthStay Program permission to complete a full background check on each adult member of my household.

    *Adult members of the household over the age of 18. If the fees for background checks for all of your family members are a hardship, please contact the program director to discuss scholarship options for your household.
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