Homestay Application Form Please complete the Homestay Registration Form below.Fields marked with an * are requiredHOMESTAY INFORMATIONApplicant’s Name: *Address (Home/Apt #, Street): *City: *Postal Code: *Home Telephone:HOST MOTHER INFORMATIONHost Mother Occupation and Place of Employment: *Host Mother Cellphone:Host Mother Work Telephone:Host Mother Email: *HOST FATHER INFORMATIONHost Father Occupation and Place of Employment: *Host Father Cellphone:Host Father Work Telephone:Host Father Email: *HOST CHILDREN AND PETS INFORMATIONChildren’s Names, Birth Dates, and Genders:Do you have pets? Yes NoIf yes, what kind?GENERAL INFORMATIONHave you ever hosted an international student? Yes NoHow many students can you accommodate?Can you provide transportation to and from the school? Yes NoDo you or any occupants smoke? Yes NoDo you have designated smoking areas? Yes NoDo you have laundry facilities? Yes NoWould the student have access to a private bathroom? Yes NoCan you provide three meals per day? Yes NoIf desired, can the student use your kitchen? Yes NoDo you have children living in the home? Yes NoWhat interests/activities are those in your household involved in?What activities would you include the student in?Family guidelines about drinking alcohol:Family guidelines about the use of home phone:When are you available to host? Any times unavailable?Additional Information:Date:
