Homestay Family Application
Contact Information
First Name
Last Name
Home Address
Postal Code
Telephone
Cell Phone
Fax
E-mail
Family Information
How many members?
Do you have any children?
Select
Yes
No
Children's names:
Children's ages:
Occupation
Hobbies
Home Information
How many bedrooms?
How many rooms available for students?
Are the student's rooms private?
Select
Yes
No
If No, how many others in room?
Does the room have a phone jack or could one be installed?
Select
Yes
No
Is there a computer available?
Select
Yes
No
Washroom shared?
Select
Yes
No
Is washroom on the same floor as students room?
Select
Yes
No
Are there pets on the premises?
Select
Yes
No
If Yes, What kind of pet?
Is smoking allowed?
Select
Yes
No
Comments:
Transportation
How far to the nearest bus stop
How many buses to the city center & Red River College?
References
Reference 1
Reference 2
Criminal check?
Select
Yes
No
Homestay Preferences
Student Age preference
Gender Preference
None
Male
Female
Nationality
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