Homestay Program Application

*Required Fields

The Following Information Is Required

Primary Contact

*Title: Mr. Ms.
*First Name:
*Last Name:
*Nationality:
*Languages Spoken:
*Age:
*Marital Status:
*Occupation:
*Working Hours:
*Business Number:
*Home Number:
*Email:
*Address:
*City:
*State/Province:
*Zip/Postal code:
*Major Street Intersection:
*Directions to nearest public transportation:

Spouse/Partner

Title: Mr. Ms.
First Name:
Last Name:
Nationality:
Languages Spoken:
Age:
Marital Status:
Occupation:
Working Hours:
Business Number:
Email:

Homestay Family Information

*Annual Family Income: $0-$20K $20-$35K $35-$50K $50K+
If you have children, list name(s) & age(s):
If you have pets, list what type(s) & how many:
*Are there smokers in the home?: Yes No
*Do you take smokers if they smoke outside?: Yes No
*What gender will you take?: Male Female Any
*Do you have Internet access for the students to use?: WiFi Computer No Access Available
What is your religion (if applicable)?:
*Describe your family: Traditional Single-parent Single Same-sex relationship

Room Information

*How many rooms do you have for homestay services?:
*Room 1:

Food Information

*Do you accept students with a special diet (ie. no pork, vegetarian)?: Yes No

Please list the type of foods you frequently prepare for

*Breakfast:
*Lunch:
*Dinner:

Legal Information

*Has anyone ever been convicted of a criminal offence?: Yes No
*Is anyone suffering from an alcoholic/drug problem?: Yes No
*Does anyone have behavioral problems?: Yes No

Additional Information/Photos

Add a description of your home and family that we can use to promote your homestay:
*Please submit 3-5 photos of your home: