Blank - Reimbursement Adnamemm.yy

Au Pair International Area Director Reimbursement Form

Type of Match: Au pair

Your Name: Date submitted: E-mail:

New** Rematch* New** Rematch* Extending 6 m w/ same host family Extending 9 m w/ same host family Extending 12 m w/ same host family

Send in e-mail attachment to: [email protected]

Instructions: write each host family/au pair per line. Add and delete lines as needed.

*Rematch = au pair or host family switching replacing in the middle

**New = au pair's first placement and host family starting a new prog

Arrival Reimbursement: Host Family Name

(Last, First)

In-Home Meeting Date

NA for rematch, extension or done by other AD

Departure Reimbursement: Host Family Name

Au Pair Name

Date of Arrival to

Date of Welcome Call

Host Family or Date of Extension Contact AP&HF within 48 Start hours of arrival. NA for extensions

(Last, First)

Date of Arrival Meeting" In-person meeting w/ AP& HF within 2 weeks of arrival. NA for extensions

Please to attach your updated contact log for the au pairs leaving your cluster. Arrival

Au Pair Name

Departure Date

Complete Log Enclosed

Months Served

(Last, First)

Date or month of Arrival in the US or of Extension

(Last, First)

Re-match or Early Return: last official date with Host Family. Completed: date or month Other: NA

Has Au Pair Arrived?***

Is the Family in Your Cluster?

Yes, No

Yes, No

X (month #Y - #Z) MM.YY To MM.YY

Number of Months and Month Number Arrival Month = 1 st.

Recruitment Bonus and Other: Host Family Recruited by You**

(Last, First)

State

Describe How/Where Host Family Was Recruited

e.g. Craig's list ad, magazine ad, friend, web/interest form, etc.

** AD receive a $100 recruiting bonuses per host family directly recruited by you, inlcuding leads from interest forms/company website. Referral bonuses by current host families are awarded to the family in the form of a credit towards future program fees and not to the AD. ** *Recruitment bonuses are paid after the au pair has arrived at the host family's home.

Type of Match: Host family

New** New** Rematch* Rematch* ng 6 m w/ same host family ng 9 m w/ same host family ng 12 m w/ same host family

Arrival reimbursement

$250 $175 $125 $125 $125 $125 $250

h = au pair or host family switching replacing in the middle of their program year.

au pair's first placement and host family starting a new program year (including renewal)

Type of Match* AP/HF

Reimbursement

>New AP/New HF >New AP/Remathc HF >Rematch AP/New HF >Rematch AP/Rematch HF >Extending (6, 9 or 12 m)

Sub total

$0

Au Pair Program Status

Reimbursement

Edits

Notes

Office use only

Office use only

Edits

Notes

>Extension >Completed 1st year >Completed 6, 9, 12 m ext. >Rematch >Early Return

Sub total

Host Family Was Recruited

$250 per 12 months or $20.83/month

Office use only

Office use only

Edits

Notes

Office use only

Office use only

$0

Bonus

e ad, friend, web/interest form, etc.

Sub total

$0

TOTAL

$0