Name
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Street Address
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City
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Province
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Postal Code
A value is required.
Home Phone
A value is required.
Work Phone
Cell Phone
Email
A value is required.
Fax
Names of residents living at home
Relationship
Year of Birth
Comments
Occupation
A value is required.
Company
Please make a selection.
Spouse's Occupation
Company
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Please make a selection.
What daily language is used at home?
A value is required.
Does any member of the household have any physical or mental condition that students should be made aware of?
A value is required.
Has any member of the household ever been convicted of any offence other than a traffic violation?
A value is required.
Do you have a family pet? If so, what kind?
A value is required.
Name a few of your family’s interests and hobbies:
An entry is required.
Please make a selection.
Would you allow a student to smoke outside your home?
Please make a selection.
Are you able to host students with special diets (vegetarian or other)?
Please make a selection.
Which kind of student accommodation will you provide?
Please make a selection.
Have you hosted a student before?
Please make a selection.
If you have hosted before, which year, and for which school or agency?
What are your reasons for hosting?
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List two personal or business references below: Name
A value is required.
Phone
A value is required.
A value is required.
A value is required.
Referrals — Names of people that may be interested in hosting international students: Name
Phone
The completion of this application does not confirm the placement of any student(s) in your home.
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