Page Host Application Form Rules for Page Hosts Single individuals may only host students of the same gender. Married individuals may only host pages of the same gender as your child(ren). Homes with both male and female children will not be allowed to host pages. Each page must be provided with his or her own bed. Host Family Responsibilities Provide Pages with transportation to and from the Governor’s Office at 116 West Jones Street each day. Pages with a valid driver license may be allowed to drive themselves with the permission of their parents. Provide breakfast and dinner each day from Monday evening through Thursday morning, including snacks during the evening. Provide appropriate hospitality and supervision, clean living area, linens and towels for each page. Collect payment of $100 for lodging from pages. Review Parental/Guardian Permission Form for guidance on appropriate after-work activities or pertinent medical conditions. Help enforce the dress code by monitoring page attire before they leave your home daily. Communicate with page parents concerning any responsibility for damages during their stay. Note: The Governor’s Office will not be responsible for any damage done by pages. Home Visit After you submit your application, the Page Coordinator will schedule a home visit to assure that your home is suitable for Pages. Schedule Pages must report on Monday at 1:00 p.m. to the Governor’s Office in the Administration Building, 116 West Jones Street, downtown Raleigh. Tuesday through Thursday, pages serve from 9 a.m. until 4 p.m. Dress Code Pages are expected to dress in business attire each day. Young men are required to wear dress slacks, coat and tie each day. Young women are expected to wear a skirt and blouse, a dress or a pantsuit each day. Pages should wear comfortable shoes for walking and dress appropriately for weather conditions. Contact Information Page Coordinator Email: govpage@nc.gov Office: (919) 814-2069 Host Information Full Legal Name: * Street Address, City, State, Zip: * Home Phone: * Please format as XXX-XXX-XXXX Work Phone: Please format as XXX-XXX-XXXX Cell Phone: Please format as XXX-XXX-XXXX Email Address: * Date of Birth (Can be provided by phone) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 NC Driver's License Number (Can be provided by phone) Place of Employment: * Are there any other individuals residing in home? * - Select -YesNo Full Name of Spouse or Other * Date of Birth (Can be provided by phone) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 NC Driver's License Number (Can be provided by phone) Full Name Individual #2 Date of Birth (Can be provided by phone) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 NC Driver's License Number (Can be provided by phone) Full Name Individual #3 Date of Birth (Can be provided by phone) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 NC Driver's License Number (Can be provided by phone) Full Name Individual #4 Date of Birth (Can be provided by phone) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 NC Driver's License Number (Can be provided by phone)
