Formulario

Student Homestay Application
IF YOU HAVE A PROMOTION CODE PLEASE ENTER IT HERE
PROMO CODE
Student's Name*

First NameLast Name
Student's Birth Date*

MonthDayYear
Student's Gender*
Complete Mailing Address*
Student's E-mail*
WhatsApp Number
Homestay Start Date*

MonthDayYear
Homestay End Date*

MonthDayYear
School Information - Homestay Expectations
School Name*
Campus if Applicable:
In the city of*
Course Start Date

MonthDayYear
Homestay Category*
Please select the amount of time would you like spend with host family*

Frequent interaction with my hostfamily is very important to meI am independent, moderate interaction with my host family is sufficientI am very independent. I want freedom and infrequent interaction with my host family
What do you expect of your host family?
Please note that we will try our best to accommodate your expectations BUT we do NOT Guaranteed their availability.
English Level*
Type of Meal Plan*
Preferences of your family

ChildrenPetsOther StudentsTeenagers
Medical Information
If you have allergies or food that you Do Not Eat, please describe them here.
If you are taking medications please describe them here.
WILL YOU ACCEPT PLACEMENT IN FAMILIES WHERE THERE ARE SMOKERS*

YesNo
Do you smoke?*

YesNo
If you would like to add anything to your Application, please indicate them here.
Emergency contact information
Emergency Name*
Name of Emergency Contact
E-mail of Emergency Contact*
Cell phone of Emergency Contact*
Phone# of Emergency Contact
Relation to Emergency Contact*
Agent Information

If you are an agent representing the student please complete the information below.
Agent Name
Name of Representative
Agency Name
Name of the Agency
Agent Email
example@example.com
Airport Transportation Services
ARRIVAL INFORMATION

Please indicate your arrival details even if you do not require transportation services so that we can ensure the homestay is available to welcome you. Arrival date could also mean your move-in date to the homestay.
Type of service*
Airline
Flight
Arrival Date & Time*

MonthDayYearHourMinutes
Airline
Flight
DEPARTURE INFORMATION

If you do not require airport drop off services please leave the fields blank.
Departure Date & Time

MonthDayYearHourMinutes
Should be Empty:

Student Homestay Application

School Information - Homestay Expectations

Medical Information

Agent Information

Airport Transportation Services