Application Form

Agency Name :

Applicant Name (required):

D.O.B (Date of birth):

 Male Female

Your Email (required):

Telephone (required):


Address (House # / Street Name / City / Prov. / Postal Code):


Name of the school:

Visa Type:

Check In:

Check Out:

Airport Pick-up:
 Yes No

Flight Information:

Other residents:
 Young Children No young Children Teenagers No teenagers Adult Only Other students No preference

Do you like pets?
 None Dogs Cats Other

Are you a smoker?
 Yes No

Do you drink?
 Yes No

Meal Plan?
 2 Meals 3 Meals None

Special Request:

What are the foods you cannot eat?

Copy of your passport (Max. 2 MB)

Copy of your e-Ticket (Max. 2 MB)

I (We) confirm the accuracy of all information enclosed in the Homestay Request Form.