Homestay Application Form If you are a human and are seeing this field, please leave it blank. Date: Homestay Mother/Father's Name: Address: Postal Code: Email: Homestay Mother Occupation: Homestay Father Occupation: Homestay Mother Work Telephone: Homestay Father Work Telephone: Homestay Mother Home Telephone: Homestay Father Home Telephone: Homestay Mother Cellphone: Homestay Father Cellphone: How did you hear about this program? Have you ever hosted an international student in your home? Yes No How many students do you wish to accommodate at one time? 1 2 3 4 5 6 7 8 9 Do you prefer a male or female student? Female Male No Preference Would you host young students (12 to 16 years old)? Yes No Can you provide transportation to and from the school? Yes No Do you smoke or do other occupants in your home smoke? Yes No Do you have a designated smoking area? Yes No Do you have laundry facilities? Yes No Would the student have access to a private bathroom? (not necessary) Yes No Can you provide three meals each day? (Note that the noon meal will be a box lunch on Monday through Friday.) Yes No If so desired, can the student have use of your kitchen area? Yes No Do you have children living at home? Yes No If yes, please give names and ages. Do you have pets? Yes No If yes, please give names and ages. What group interests/activities are those in your household involved in? In what kind of activities would you include the student? What are your family guidelines about the drinking of alcohol? What are your family guidelines about the use of your home phone? What type of internet is available in your home? Wired Wireless Both None From what country would you like to host a student? Asia Middle East Europe South America North America Quebec Other No Preference Desired length of stay: Short-term stay (1-4 weeks) Long-term stay (5 weeks +) No Preference Can a student stay for a longer period of time in your home, if necessary? Yes No Desired age range of student: 12-16 17-25 26-40 41+ When would you be available to host a family and are there any times of the year when you would not be available to be a homestay family? Please Share any additional information you wold like us to know.
