HOMESTAY PROGRAM   -    STUDENT APPLICATION    -    HOMESTAY FAMILY  APPLICATION

 

STUDENT HOMESTAY APPLICATION

CONTACT INFORMATION:
1. First Name: 2. Last Name:
3. Sex:
4. Birth date:
5. Home address:
6. Phone: 7. Email:
8. Nationality: 9. Fax:
ARRIVAL INFORMATION:
10. Arrival Date:
11. Arrival Time:
12. Flight number:
13. Length of stay in Canada:
14. Name of school attending in Winnipeg:
MEDICAL INFORMATION:
15. Do you have any medical conditions? (yes / no)
16. If yes, please explain:
17. Are you under doctor care at present? (yes / no)
18. Are you allergic to anything? (yes / no)
18. If yes, please explain:
PERSONAL CHARACTERISTICS:
27. Do you smoke?
28. Which one best describes you
18. Do you spend a lot of time at home? (yes / no)
18. Do you enjoy an active social life? (yes / no)
18. What sports do you enjoy? (yes / no)
18. What is your favorite music? (yes / no)
18. Other hobbies:
ADDITIONAL INFORMATION & COMMENTS:
1. Do you want a private room? (yes / no)
3. Would you live with a family that has children? (yes / no)
3. Would you live with a family that has pets? (yes / no)
3. Would you live with a family that smokes? (yes / no)
3. Would you live with a family that has another international student? Our placement policy guarantees you'll never be placed in a home with a student who speaks your first language. (yes / no)
4. English Level & Program Information: please comment on your English level & what ESL program you have chosen. ie. impact, access,TOEIC

                                       

Phone:      204-479-9946 

Fax:        204-284-4174

Email:    polartrails@canada.com ,   www.polartrails.com

POLAR TRAILS INC.  148 BARTLET AVENUE, R3L 0Z1, WINNIPEG, MB  CANADA