Student Application form for home-stay and services

Please fill out the following questions then submit the form with your non-refundable registration fee click here for pricelist and a non-refundable administration fee.

If you need airport pick up service, additional fee applies.

Contact / Student Information
Last Name
First Name
Today's Date / / Format: MM/DD/YYYY
Phone
Email
Emergency Contact Person
Emergency Phone
Address
City
State
Postal Code
Country
Citizenship
Birthplace
Date of Birth / / Format: MM/DD/YYYY
Gender
Arrival Information
Length of Home stay: First Day Last Day
Do you need airport pick up? no yes (one way) yes (round trip) -- please indicate one.
Airline
Flight Number
Flight Time
Arrival date / / Format: MM/DD/YYYY
Choose a Homestay Plan
breakfast & dinner - private room
breakfast & dinner - share room with companion
companion’s name
(must travel together - companion needs to complete and sign his/her own application form!)
Private room - Breakfast only
Private room - No meals Single person only
Private Bath?
School Information
Name of School
Address of School
Phone of School
Medical Insurance Status (check one)
Need medical insurance
Have medical insurance (I will provide proof on arrival)
Complete the following information so we are better able to place you with a family which suits your needs.
Do you smoke? yes no, (if yes, smoking only outside)
Stay with a host who smokes? yes no
Allergies? yes no
If yes, please explain?
Any food you do not eat due to your religion? yes no
Hobbies?
Personality Type  
Quiet
Active
Outgoing
Talkative
Other
Level of English  
Beginner
Intermediate
Advanced
Form of transportation planned to use?  
Public
Car
Other
Other necessary information  
(optional)
Terms and Conditions
Click here for Terms and Conditions
By entering your name in this box, you are providing an electronic signature and stating that you agree to our terms and conditions:
Name
Date