Full name of Applicant:
(first name)
(last name)

(postal code)

Home Phone:
Cell Phone:


Host Father Occupation:
Host Mother Occupation:
Host Father Education:
Host Mother Education:
What is your first language:
What is your second language:
Have you ever hosted an international student in your home?
Yes No
How many students do you wish to accommodate at one time?
Do you prefer a male or female student?
Male Female No Preference
Would you host young student(12 to 20 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
What kind of home do you have?(please circle):
 Detached    Semi-detached    Townhouse    Condo    Apartment

What kind of food style do you cook?
Can you provide three meals each day?(Note that the noon meal will be a box lunch on Monday through Friday.)
Yes No
Do you provide fruit for each meal?
Yes No
If so desired, can the student have use of your kitchen area?
Yes No
Do you have children living at home?
If yes, How many?
Yes No
Do you have pets?
Yes No
Are students allowed to have pets?
Yes No
What group interests/activities are those in your household involved in?
What kind of activities would you include the student in?
What type of internet is available in your home?
Wired Wireless
From what country would you like to host a student?
Middle East
South America
North America
No Preference
Please share any additional information you would like us to know.
*Upload your house photos here(at least one to maximum 3 photos):

How many rooms are available for homestay service?

Room No.{{index+1}} Information:
Size of the room in square feet?
Size of bed?
On which direction is the room facing?
Number of window in the room?
Where is the room located?
 Basement    First floor    Second floor    Other(please specify) 
How many people share the bathroom?(including the student)
Room available from
How much per month is your homestay service for this room?
*Upload your room photos here(at least one to maximum 2 photos):
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