Gallery Houston Activities

 

Application Form

Step 1: Fill out and e-mail the form below or click here to print out the form and fax to (713) 772-3390.
Step 2: If transportation is needed, please go to Transportation page or click here to print out the form and fax to (713) 772-3390.
Step 3: Be sure to double check that all fields are filled out properly with the correct information before sending.

Select a program:
1. $1150.00 per month plus fees (14 meals per week) ABOVE AVERAGE PROGRAM
2. $1050.00 per month plus fees (12 meals per week) STANDARD PROGRAM
3. $850.00 per month plus fees (NO meals included in this program) ECONOMY PROGRAM
4. Other programs*
 
Family Name: *
 First Name: *
Address:
City:
Country: *
 Zip Code:
Telephone:
Fax:
E-mail: *
 
1. Country of Birth:
Nationality:
2. Gender:
Male Female*
 Civil Status:
Single Married
3. Date of birth: Month: * Day: *
 Year: *
4. Level of Education:
5. What is your current or future occupation?
6. What are your hobbies?
7. Do you smoke?
Could you live in a home that has smokers?
8. Could you live in a home that has a dog?
Could you live in a home that has a cat?
9. Are there any foods that you cannot eat?
(DOES NOT APPLY TO THE ECONOMY PROGRAM #3)
10. Do you have any allergy or health problems?
11. Will you have access to an automobile:
12. How many months will you be in your Homestay?
13. Arrival Date:
Arrival Time:
Airport Name:
Airlines:
Flight Number:
14. Name of the school that you will attend? *
15. Date of arrival at the homestay home: *
16. On the following box, please describe yourself to your American Homestay Family:

Application:

To apply for Homestay Houston by e-mail or fax please click on the first link below. If you need transportation from the airport to the home please click on the second link as well.

Homestay Application Form

Transportation Form

Please read all the details about the Placement Fee before sending your Application Form.