HOMESTAY APPLICATION FORM
Family Name: First Name:
Address:
City: Country: Zip Code:
Telephone: FAX: E-Mail:
1. Country of Birth: Nationality:
2. Sex: Female Male SELECT ONE Check only one box: Single Married
3. Date of Birth - Month: Day: Year:
4. Level of Education: High School University SELECT ONE
5. What is your current or future occupation?
6. What are your hobbies?
7. Do you smoke? No Yes SELECT ONE Could you live in a home that has smokers? No Yes SELECT ONE
8. Could you live in a home that has a pet? No Yes SELECT ONE
9. Are there any foods that you cannot eat?
10. Do you have any allergy or health problems?
11. Will you have access to an automobile? No Yes SELECT ONE
12. How many months will you be in your Homestay?
13. Arrival Date: Arrival Time: Airport Name: Hobby IAH SELECT ONE Airlines: Flight Number:
14. Name of the School that you will attend:
15. On the following box, please describe yourself to your American Homestay Family.
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