Host Application: for Guest/Student application, please click here   Please fill-out all fields in this application in order to empower the agency coordinators to match students with you and your family. These are mostly yes or no questions that are important to us. Remember that you will be able to login and update your profile and availability at anytime or on regular basis.   You should receive your confidential and automatically generated password and details upon completion of this application form. Please take your time and remember that your hosting preferences can increase chances of more occupancy or decrease them.   Household Preferences Address Household (Number of occupants, number of guest accommodations, spoken languages, etc...)     Required(*) (**)Recommended Application Date     Type of home select house town house town home apartment condo ranch farm                 Home Condition select new renovated fairly new newly renovated Needs renovations Adults select one two three four Children select one two three four five none Students select one two three four five none Pets select one two three four five none Guestrooms select one two three four five none Guest suites select One bedroom suite Two bedroom suite Three bedroom suite First Language select English French -------- Arabic Bulgarian Catalan Chinese (S) Chinese (T) Croatian Czech Danish Dutch English Estonian Finnish French German Greek Hebrew Hungarian Icelandic Italian Indonesian Japanese Korean Latvian Lithuanian Norwegian Persian Polish Portuguese Romanian Russian Serbian Slovak Slovenian Spanish Swedish Turkish Second language select English French None -------- Arabic Bulgarian Catalan Chinese (S) Chinese (T) Croatian Czech Danish Dutch English Estonian Finnish French German Greek Hebrew Hungarian Icelandic Italian Indonesian Japanese Korean Latvian Lithuanian Norwegian Persian Polish Portuguese Romanian Russian Serbian Slovak Slovenian Spanish Swedish Turkish Any Smokers! select yes, smoke outside yes no Family Health select excellent good some challenges some concern Hobbies & Activities Homestay experience select yes no   Smoke detector select yes no               Hosting Preferences (why do you wish to host or who do you prefer to host)     Required(*) (**)Recommended Why would you like to host students or house guests? Prefer hosting select males females both Meals preference select **three meals **bkfast and dinner breakfast and lunch lunch and dinner dinner lunch breakfast no meals Ages 12  to 18 yrs. select yes no Ages 19 and older select yes no Accept couples select yes no We accept smokers select yes, smoke out yes no Prefer hosting select students trainees practicum athletes visitors all above Physically Challenged select the blind minor disability wheel chair access all above none of the above         Home Address & Contact Details*     Required(*) (**)Recommended Street Address   City State/Province Country select country Canada U.S.A. U.K. ------------ Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Botswana Brazil British Virgin isl. Brunei Bulgaria Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Irak Iran Ireland Ireland, Northern Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kuwait Kyrgyzstan Latvia Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Rwanda Saba Saipan Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey Turkmenistan United Arab Emirates U.S. Virgin Islands U.S.A. Uganda United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Yemen Zaire Zambia Zimbabwe Postal Code Email Home Tel. Cellular Work Tel.         Host one Host two Host three Children Students House Pets Primary Host*     (* ) Required (**) Recommended First Name Last Name Occupation Gender select female male Age Group select 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81+ Marital Status select married com. law single Do you drive? select yes no Driver Licence         Second Host* (adults only who shares household duties)     Required(*) (**)Recommended First Name Last Name Occupation Relationship select husband wife boy friend girl friend brother daughter son sister mother father cousin niece grand father grand mother Age Group select 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81+ Cellular         Additional Host* (additional adult only who lives in the household, if any)     Required(*) (**)Recommended First Name Last Name Occupation Relationship select daughter son brother sister mother father cousin niece grand father grand mother friend son in law daugher in law other Age Group select 21-25 26-30 31-35 36-40 41-45 46-50 51-55 56-60 61-65 66-70 71-75 76-80 81+ Cellular         Children* (children in the household)     Required(*) (**)Recommended 1st Child Name Age select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Gender select female male     2nd Child Name Age select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Gender select female male     3rd Child Name Age select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Gender select female male             Students or Guests* (students who are presently in the household)     Required(*) (**)Recommended Student 1 Name Citizenship country of origin Canada Germany Japan Saudi Arabia South Korea Switzerland U.K. U.S.A. ------------ Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Botswana Brazil British Virgin isl. Brunei Bulgaria Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Irak Iran Ireland Ireland, Northern Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kuwait Kyrgyzstan Latvia Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Rwanda Saba Saipan Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey Turkmenistan United Arab Emirates U.S. Virgin Islands U.S.A. Uganda United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Yemen Zaire Zambia Zimbabwe Gender select female male Age Leaving on Occupying select room 1 room 2 room 3 Student 2 Name Citizenship country of origin Canada Germany Japan Saudi Arabia South Korea Switzerland U.K. U.S.A. ------------ Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Botswana Brazil British Virgin isl. Brunei Bulgaria Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Irak Iran Ireland Ireland, Northern Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kuwait Kyrgyzstan Latvia Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Rwanda Saba Saipan Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey Turkmenistan United Arab Emirates U.S. Virgin Islands U.S.A. Uganda United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Yemen Zaire Zambia Zimbabwe Gender select female male Age Leaving on Occupying select room 1 room 2 room 3 Student 3 Name Citizenship country of origin Canada Germany Japan Saudi Arabia South Korea Switzerland U.K. U.S.A. ------------ Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Barbuda Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire Botswana Brazil British Virgin isl. Brunei Bulgaria Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Rep. Chad Channel Islands Chile China Colombia Congo Cook Islands Costa Rica Croatia Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faeroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Irak Iran Ireland Ireland, Northern Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kuwait Kyrgyzstan Latvia Lebanon Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar/Burma Namibia Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Reunion Rwanda Saba Saipan Saudi Arabia Scotland Senegal Seychelles Sierra Leone Singapore Slovak Republic Slovenia South Africa South Korea Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tanzania Thailand Togo Trinidad-Tobago Tunisia Turkey Turkmenistan United Arab Emirates U.S. Virgin Islands U.S.A. Uganda United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wales Yemen Zaire Zambia Zimbabwe Gender select female male Age Leaving on Occupying select room 1 room 2 room 3         Pets* (pets in the household)     Required(*) (**)Recommended Pet 1 - Name Type select dog cat bird rabbit hamster fish reptile other Breed Other Type Pet 2 - Name Type Type select dog cat bird rabbit hamster fish reptile other Breed Other Pet 3 - Name Type select dog cat bird rabbit hamster fish reptile other Breed Other Type         Guestroom one Guestroom two Guestroom three Guestroom One: (description of furnished guestrooms at your home and in-room amenities)     Required(*) (**)Recommended Room Reference Room 1 Room Status select vacant ready vacant not ready soon vacant occupied Available from Available to Room Location select third floor second floor first floor main level ground level ground level suite basement suite in a condo in an apartment other Size in feet select smaller 90 100 110 120 130 140 150 160 170 180 190 200 larger Opening Window select yes no Locking door select yes no Hydro/Electricity select included excluded Heat & hot water select included excluded Furnished select yes no Bed type select standard bed sofabed hidabed futton water bed airbed raised airbed mattress only other Bed size select single twin double queen king sultan 2nd bed (if any) select none single twin double queen Closet/Wardrobe select yes no Desk with a chair select yes no Bedside table select yes no Dresser select yes no Mirror select yes no Alarm clock & radio select yes no TV and Cable select in-room shared Internet Access select wireless high-speed cable high-speed DSL shared location dail-up Bathroom select shared private ensuite Bathroom Type select full bath with shower Living room select shared private Kitchen select shared private Separate Entrance select yes no Laundry select shared coin operated nearby not available Included Meals select **three meals **brkfst and dinner breakfast and lunch lunch and dinner dinner lunch breakfast no meals Expected Rate in $ select 300 325 350 375 400 425 $450 475 500 525 550 575 600 625 650 675 700 725 750 775 800 825 850 875 900 925 950 975 1000 1025 1050 1075 1100 1125 1150 1175 1200 Room Remarks             Guestroom Two: (description of furnished guestrooms at your home and in-room amenities)     Required(*) (**)Recommended Room Reference  Room 2 Room Status select vacant ready vacant not ready soon vacant occupied Available from Available to Room Location select third floor second floor first floor main level ground level ground level suite basement suite in a condo in an apartment other Size in feet select smaller 90 100 110 120 130 140 150 160 170 180 190 200 larger Opening Window select yes no Locking door select yes no Hydro/Electricity select included excluded Heat & hot water select included excluded Furnished select yes no Bed type select standard bed sofabed hidabed futton water bed airbed raised airbed mattress only other Bed size select single twin double queen king 2nd bed (if any) select none single twin double queen Closet/Wardrobe select yes no Desk with a chair select yes no Bedside table select yes no Dresser select yes no Mirror select yes no Alarm clock & radio select yes no TV and Cable select in-room shared Internet Access select wireless high-speed cable high-speed DSL shared location dail-up Bathroom select shared private ensuite Bathroom Type select full bath with shower Living room select shared private Kitchen select shared private Separate Entrance select yes no Laundry select shared coin operated nearby not available Included Meals select **three meals **brkfst and dinner breakfast and lunch lunch and dinner dinner lunch breakfast no meals Expected Rate in $ select 300 325 350 375 400 425 $450 475 500 525 550 575 600 625 650 675 700 725 750 775 800 825 850 875 900 925 950 975 1000 1025 1050 1075 1100 1125 1150 1175 1200 Room Remarks             Guestroom Three: (description of furnished guestrooms at your home and in-room amenities)     Required(*) (**)Recommended Room Reference  Room 3 Room Status select vacant ready vacant not ready soon vacant occupied Available from Available to Room Location select third floor second floor first floor main level ground level ground level suite basement suite in a condo in an apartment other Size in feet select smaller 90 100 110 120 130 140 150 160 170 180 190 200 larger Opening Window select yes no Locking door select yes no Hydro/Electricity select included excluded Heat & hot water select included excluded Furnished select yes no Bed type select standard bed sofabed hidabed futton water bed airbed raised airbed mattress only other Bed size select single twin double queen king 2nd bed (if any) select none single twin double queen Closet/Wardrobe select yes no Desk with a chair select yes no Bedside table select yes no Dresser select yes no Mirror select yes no Alarm clock & radio select yes no TV and Cable select in-room shared Internet Access select wireless high-speed cable high-speed DSL shared location dail-up Bathroom select shared private ensuite Bathroom Type select full bath with shower Living room select shared private Kitchen select shared private Separate Entrance select yes no Laundry select shared coin operated nearby not available Included Meals select **three meals **brkfst and dinner breakfast and lunch lunch and dinner dinner lunch breakfast no meals Expected Rate in $ select 300 325 350 375 400 425 $450 475 500 525 550 575 600 625 650 675 700 725 750 775 800 825 850 875 900 925 950 975 1000 1025 1050 1075 1100 1125 1150 1175 1200 Room Remarks             Photographs Location Comments References Agreement and Submit Upload Digital Photographs* (Maximum of 300K each image file in .jpg formate)  IMPORTANT: This section is temporarily out of order, please forward photos to us via email with contact details   Hosts     Hosts     House     Room 1     Room 1     Room 2     Room 2     Room 3     Room 3     Bath 2     Bath 2     Living     Kitchen     Optional     Optional    IMPORTANT: This section is temporarily out of order, please forward photos to us via email with contact details Location* ()     Required(*) (**)Recommended Region/Metropolitan Suburb/Municipality         Map Reference from Visit multimap.com enter you full address at the corner of home page retrieve your map location click on link symbol and again on click "Generate Link". Remember to leave link title blank. Copy and past generated code in this field. Multimap.com It's a free service!           Distance to bus stop select outside our doors accross the street one block away two blocks away three blocks away four blocks away five blocks away six blocks away further away Other nearby transit select skitrain seabus metro trolli train other         Describe neighbour- hood, transit sys- tem and list schools         Comments & Feedback* ()         Comments     How did you find us? select a friend a student a colleague a neighbour school or college another agency Google search other search engine other website classified ad directory listing direct mail brochure flyer other Referrer Name                 References* (Provide two references, each should include name, relationship, tel. number, & email)         Personal Reference Professional Reference                 Term, Conditions, and Requirements* (Join our Host Families)         By submitting this application you agree to:     Do you accept Host Guidelines?  Yes No   Do agree to 10% agency commission Earnings? Yes No   Do you accept agency homestay Rates? Yes No   If necessary, would meet and show us your home? Yes No   Do you accept to submit a police report by mail? Yes No   Do you accept our disclaimer? Yes No   Download host family agreement (.pdf)     Download consent form to take to police for report
	PS. Please check your email inbox after clicking Submit