education home programs sign up

Sign Up Today to Live With An American Family   The first step is to complete our Placement Application below. If you prefer, you may also download (MS Word Format , PDF Version ) or print (Printable Version ) the form to be mailed or faxed at a later date. Please complete the form below. We look forward to working with you.

HOST FAMILY PLACEMENT APPLICATION

This form will be sent to Homestay Services via email:

** SUBMISSION INFORMATION **

Submittor Name (*required): (Name of person completing this form?)

Email Address (*required):  

** APPLICANT INFORMATION **

Homestay Applicant Name:   

(first) (last/family name)

Date of Application:  

Age:                                     Sex: Male Female

Country:      

    Phone Number: 

Fax Number: 

Address in Home Country:                      

Arrival Information        Airline:  Flight #:

Date of Flight:               Time of Arrival:  

                   ( Unless otherwise notified, we will pick you up at the airport !! )

Which School or University Will You Attend (If Any):   

Do You Smoke?  No Yes        ( If "Yes", Can You Smoke Outside?  No Yes )

Can You Live With a Family that has a Dog Inside?    No Yes

Can You Live With a Family that has a Cat Inside?    No Yes

Can You Live With a Family that has Small Children (under Age 10)?    No Yes

Who Do You Want Food Provided By?   Host Family Yourself

Which Date Will Be Your First Day of Homestay?     

Which Date Will Be Your Final Day of Homestay?

What Form of Transportation Will You Use?  Car   Public Transportation   Other

Other Information (Please Let Us Know If You Have Any Special Requests, Requirements or Restrictions):

What is the Best Time to Reach You?: 

What is the Best Way to Reach You?:  

Please contact me as soon as possible regarding this matter.