Telephone: 604-628-8491 fax: 604-648-8201
E-mail: info@northwesthomestay.com
www.northwesthomestay.com
  
 
HOMESTAY HOST APPLICATION FORM

Please note that the symbol [ * ] indicates a required field. Applications submitted without this information cannot be processed.

If the question doesn't apply to your family please write NA
Date of birth
(date/month/year)
Occupation
1st Language
*Name:
*Spouse:
*Street Address:
*City, Province:
*Postal Code:
*Phone: (Home)
Work: (His)
(Her)
Cell:
Fax:
*E-mail:
 

* 1. Please list all other members of your household : (Please write NA under name on the first box if the question doesn’t apply to you.)

NAME
RELATIONSHIP
DATE OF BIRTH
SCHOOL
OCCUPATION
1 st LANGUAGE
           
* 2. Why are you interested in hosting an international student?
 

* 3. What are your family's interests and hobbies? To what other countries have you travelled?

 

4. List any civic, religious or professional organisations to which you belong (optional).

 

* 5. Does anyone in the house smoke? Yes No
      Is smoking allowed inside the home? Yes No
      If not, do you allow smoking outside? i.e., on sundeck, patio or back porch, etc.? Yes No

* 6. List all the pets that you have and indicate whether they are indoor or outdoor pets. If You don't have any pets please write N/A

 

* 7. What type(s) of food do you prepare most of the time? (e.g., Canadian/Western, Chinese, Italian, etc.)

 

* 8. Do you rent or own your home? House Townhouse Condo Other

* How many bedrooms in your home?
* How many bedrooms are available to students?
* How many full bathrooms are there in your home?
* Half bathrooms?
You can choose multiple
* Student will: have own bathroom share with another student share with other family members
 
* 9. Do you have Internet access or Wireless Internet?
 

* 10. Distance from home to Downtown Vancouver: minutes; By bus # , ,

Walking distance from home to the bus stop: minutes
Routing options to travel to Downtown:
 

11. With what previous/other homestay schools/ agencies have you dealt?

School: Contact person: Telephone:

School: Contact person: Telephone:

School: Contact person: Telephone:


* 12. Student preferences: Male Female Either Minimum age:

Maximum length of stay: Weeks/Months

You can choose multiple
Can you accommodate: Couples Children Pets Vegetarian diets Private Bathroom


13. Write anything else that you feel is important to tell your prospective student. (e.g., house rules)

 
* 14. Do you agree to provide North West Homestay with a criminal record check from the police at your own expense for every member of your household age 16 years and older?

* 15. Please list two personal references (non-relatives) – Name, address, telephone and relationship to you:

 

The information that has been provided is true and correct to the best of my/our knowledge.


* Host family representative name: Date:

   Host family representative name: Date: