Homestay Application Form

Apply today to become a homestay family!

Please Complete the Homestay Application Form, including as much information as possible.

* = required field

Name *

Name of Spouse

Address *

Postal Code *

Occupation of Host Mother

Occupation of Host Father

Phone Number (home) *

Cell Number

Phone Number (work)

Email address

How did you learn about this program?

Are you willing to have a police record check done? *

Yes No

How you hosted international students before?

Yes No

Would you like to host student from *

Asia Middle East Europe Other

Do you prefer students who will stay for: *

1-4 weeks 2-3 months 3-6 months 6 months+

When are you available during year to host a student? *

Spring Summer Fall Winter All year Other

How many students do you wish to accommodate?

Do you prefer a male or female student?

No Preference Male Female

What age of student(s) do you prefer? *

10-15 16-18 19-30 31-50 51+

In your home, will the student(s) have access to:

Private bedroom?

Yes No

Washer and dryer?

Yes No

Share bathroom

Yes No

Transportation to and from school
(if further than walking distance)

Yes No

3 meals per day (noon meal is a box lunch Mon - Fri)?

Yes No

Do you have a private bathroom (not a requirement)?

Yes No

If desired, may a student use your kitchen area?

Yes No

Would the student(s) have access to a computer?

Yes No

Do you have wired or wireless Internet in your home? *

Wired Wireless Both No Internet

Do you or any other occupants in your home smoke?

Yes No

Do you permit smoking in your home?

Yes No

If you have children living at home, what are their names, and when were they born (month/year)?

Do you have working smoke detectors on each floor? *

Yes No

If you have pets, how many and what kind?

What family activities would you involve the student(s) in?

Briefly describe your home:
(number of bedrooms, bathrooms, social rooms, etc)

What are your family guidelines about the drinking of alchohol?

What are your family guidelines about the use of the phone?

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