Homestay Application for Students

Fields marked * are required.

General Information

I am applying for*

Temporary Housing Upon Arrival (2-5 days)
Special Short-term Program (2-4 weeks)
Long-term Stay (2 + term)

Last (Family) Name*

First (Given) Name*

Date of Birth (Month/Day/Year)*

Gender*

Address*

Phone Number*

E-mail

Country of Residence*

Nationality*

Passport Number*

Native Language*

Student ID (if available)

Level of English Language*

No English

Beginner

Intermediate

Advanced

Have you ever been to a foreign country?*

Yes

Family Information*

Mother's Name Mother's Occupation

Father's Name Father's Occupation

Please provide an address for one parent*

Which parent is this address for?*

Mother
Father

Emergency Contact in Home Country

Full Name*

Address*

Country*

Phone*

Personal Information

Favorite Hobbies and Interests*

Would you prefer small children in your host family (under 6 years old)?* Yes No No Preference

Would you prefer older children in your host family (between 6 and 18)?* Yes No No Preference

Would you be comfortable with a family that owns a dog?* Yes No No Preference

Would you be comfortable with a family that owns a cat?* Yes No No Preference

Would you be comfortable with a family that smokes?* Yes No No Preference

Do you smoke?* Yes No

Do you plan to have a car during your homestay?* Yes No

Do you practice religion?* Yes No

Please list any special physical or emotional conditions you have that could affect your homestay placement*

Please list any health problems, allergies, or dietary restrictions*

Please list any foods you cannot or do not like to eat*

Your Personality

Please check all which describe you*

Quiet

Tidy

Cautious

Religious

Noisy

Shy

Cheerful

Messy

Open-Minded

Picky Eater

Outgoing

Independent

Frugal

Organized

Serious

Private

Talkative

Athletic

Energetic

Nervous

Calm

Other

Please write a letter to your host family to tell them what you would like them to know about you.

What are your hobbies and interests (examples: movies, camping, sports, computers)?

Describe your hometown - is it a big city, countryside, how many people live there?

Describe your life with your family and friends.

Do you have any pets?

Describe your personality

Why do you want to live with a host family?

Other Information

Arrival Date

Arrival Time

Arrival Airline/Flight Number

Program Agreement

In my homestay, I agree to:

Treat all host family members with respect.

Make every effort to adapt to my new home and become part of the family.

Follow my host family's household rules.

Bring guests into my host family's home only with prior permission.

Not drink any alcohol, including beer and wine, if I am under 21 years old. I also understand that the use of any illegal drugs is strictly forbidden, and if I am caught using them I will be asked to leave my homestay immediately.

Only make long distance telephone calls at my own expense (possible ways to do this: cell phone, pre-paid telephone card, internet services, such as Skype).

Pay for any damages I cause to the host family's home or property.

Pay my homestay fees on time, directly to the host family.

I have read and understood the program agreement. I agree to follow the homestay policies listed on this agreement.*