Homestay Application Form for Students Looking for Homestay

2007-01-25T14:11:00.000-08:00

Homestay Central Personal Placement APPLICATION HOMESTAY FORM Thank you for your interest in Homestay Central personal placement Homestay program. To assist us in matching you with the most suitable Homestay Host please complete this application and return it to the Homestay Central admin center as soon as you have confirmed and paid the placement fee. You may also complete the airport pickup request form at this time if you have booked your flight and need transportation from the airport to your home stay. The Homestay will only be reserved on receipt of fully completed application form and the non-refundable placement fee. Option One Homestay (includes meals) The cost of homestay is $700-$800 per month which includes three meals a day. Guests/Students pay their homestay fee to the hosts on arrival and in addition pay a one-time fee of $200.00 security deposit to the host (see homestay agreement for details). Please note that students will usually prepare their own breakfast and lunch and the host will prepare the evening dinner. You must provide at least one months notice to the host if you decide to leave. Option Two Room in House with Kitchen privileges (does not include meals) If you would like to purchase and prepare your own meals, we can arrange for you to stay with a host who provides a bedroom with access to their kitchen to prepare meals. The cost for this option is $450 - $500 depending on the location and amenities provided. Guests/ Students are required to pay deposit of $200.00 plus first month rent to the host on arrival. Name of School Attending Start Date Finish Date Estimated date of arrival _______________ ________ __________ ______________________ _____________________________________ PERSONAL INFORMATION Name: __________________ ______________ Family Name Given Name Male Female Address: ________________________________________________________________ Street Address ___________________ ____________________ _________ City Country Code Student Number: _______________ Date of Birth: _______ Home Phone: ____________ Family Phone No: _______________ Family Email: ___________________ Students email: __________________ Nationality: ____________ First Language: _________ Please check the appropriate box that would best describe your character: Leader Adapts easily Independent Shy Have you lived away from home before? Yes if yes, for how long? ________________________________ No Have you ever been employed? Yes ___________________ No Sports/Hobbies: ____________________________________________________________________ _______________________________________ Your Accommodation Preferences Please select by numbering 1, 2, and 3 the most important features of the homestay you require. ¨ I would prefer a homestay within 20 minutes walk of the campus/work ¨ I would prefer a homestay without young children ¨ I would prefer being the only guest/student in the home ¨ I would prefer being the only guest/student from my country in the home ¨ I would prefer homestay without pets ¨ I would prefer a homestay that will accept a smoker who smokes outside ¨ I would prefer a homestay with young children Please note that we will endeavor to place students in the most suitable accommodation we have available. Homestay Central cannot guarantee that students will be placed in their first choice accommodation. Do you smoke? Yes No Yes No Are there any food restrictions or religious requirements? Do you consume alcohol? Yes No MEDICAL INFORMATION Please check allergies or special needs you may have and list. If you do not have any allergies or special needs please move on to the next questions. ¨ Allergic to animals If yes, what animals _____________________________________ ¨ Allergic to medications If yes, what medications ________________________________ ¨ Allergic to foods If yes, what foods ______________________________________ ¨ Other allergies (please list ¨ Are there any food restrictions or religious requirements that we should know about? ¨ Special needs (please explain fully what these needs might be) _________________________________________________________________________ INCASE OF AN EMERGENCY Contact Persons Name: ________________________________________________________ Relation to student: ________________________________________________________ Address: _____________________________________________________________________________ City: ___________________ Country: ________________ Code: __________________ Telephone Number: _____________ Fax Number: _____________ Email______________________ All STUDENTS MUST HAVE MEDICAL INSURANCE DURING THEIR STAY IN CANADA Every International Student studying in Canada MUST have health insurance as long as he/she is registered. I _____________________ confirm that the information contained in this document is legitimate and I agree to comply with all the conditions stated. Applicants Signature __________________ Date: _________________________ If the applicant is less than 21 years old, please have a parent co-sign below. Parents Signature: ___________________ Date: ______________________ GUEST/STUDENT HOMESTAY AGREEMENT It is very important to us that you feel comfortable with your homestay host. We have personally inspected your home and have used information forwarded to us in hopes of making the best possible” fit.” To be fair to both International students and homestay hosts we suggest that both students and the homestay host respect the following guidelines concerning payment of fees. Please ensure that you have sufficient Canadian funds or travellers cheques available to pay the host on arrival as bank drafts can take up to two months to clear in Canada. Homestay Fee $700-$800 per month (depending on area) Fee is paid in advance at the beginning of each month. Placement Fee $200.00 CN- (Paid with application) Security Deposit $200.00 CN- (Paid with placement fee) Room Rental Fee see above- (Pay Hosts on arrival) The above placement fee/security deposit is payable to Homestay Central with application. LEAVING THE HOMESTAY Guests/Students must give one month’s written notice to the host. If they do not, their security deposit (Can $200) is forfeited. In the event of a health and safety issue, we will move the guest/student to a new home without delay. In the event the student wishes to move due to personal reasons they are responsible for finding their own homestay. I have read and agree to abide by the homestay guidelines. Dated: _______, 200( ) Signed Guest/Student Homestay Host International Guest/Student Placement Administrator