Homestay Application

Submitted by i.e. applicant name, parent, organization, or other:

Subject : Student Homestay ApplicationVisitor Homestay Application for host family application, please click here

Student/Visitor Information:

First Name: Last Name: 

Home Address:

City/Town:   Province/State:

Country: Postal/Zip Code:

Email Address: Phone :

Gender: Male:  Female:   Nationality    Age:

Date of Birth (mm/dd/yy):   Passport No.

If you there are additional visitor/student, please fill out separate application for

each person, let us know here 

Parent(s) Information

Parent Name(s) :

Street Address:

City/Town: Province/State:

Country: Postal/Zip Code:

e-mail: Phone:

Important: Please recheck your email and phone number for any typo.

Emergency Contact, if different than parent(s)

Name: Telephone:

Homestay Requirements

Homestay Dates (mm/dd/yy): From:   To:

Level of accommodation required: Select Level...StandardSemi-DeluxeDeluxe (with private bath)Deluxe Studio Suite (with kitchen)

Without Meals:   With meals:  Select meals plan...with three mealswith two mealswith Breakfast onlywithout meals

Do you accept the homestay program rates?  Yes    No

Knowledge of English language:   Beginner Intermediate Advanced

Hobbies:

Career Goals:

Which school will you be attending in Vancouver? 

School Name:

School Address: 

School start date:(mm/dd/yy)

Do you have a Student Visa?  Visitor Visa?  Resident Visa?

Canadian Citizen?  none, so far?

Do you have Medical Insurance?                Yes      No 

If no, will you purchase insurance?             Yes      No 

Do you smoke?                                         Yes      No

IF YES, are you willing to smoke outside?    Yes      No

Do you drink Alcohol?                                Yes      No

Is a home with a pet acceptable?                Yes      No

Do you have allergies?                               Yes      No

If yes, caused by:     

Do you have any physical disabilities?         Yes      No

If yes, please explain:

Do you require special medical treatment?  Yes       No

If yes, please explain:

Do you need a special diet?                        Yes      No

If yes, please explain:

Additional comments, questions, concerns

How did you hear about us? If you found us on the Internet,

which search engine did you use and what did you type?    

Flight information, if available: 

Arrival date to Vancouver: mm/dd/yy   

Airline: Flight#

Arrival time: (i.e. 00:00 hours)  PST

Airport pickup service required?  Yes:(cost $75 - most recommended)    No:

Pickup and drop off package (Cost CND $150)

Do you accept homestay agency placement one-time fee of CND $160?  Yes  No

Do you agree to Student or Visitor Guidelines?  Yes      No

If you are sharing the room with a friend or a relative, please fill another application for a second person. By submitting this application you acknowledge that you true and binding.