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Personal Information
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| Last Name |
|
| First Name |
|
| Date of Birth |
day month year
|
| Address |
|
| City |
|
| Country |
|
| Postal Code |
|
| Phone |
|
| Fax |
|
| Nationality |
|
| Native Language |
|
|
Homestay Details
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| Do you smoke? |
Yes No |
| Do you prefer to stay with a family: |
with children without children no preference
with pet without pet no preference
smoking family non smoking family no preference
|
| Do you have any allergies? |
No Yes |
| Are you taking any medication? |
No Yes |
| Do you have any disabilities? |
No Yes |
| Are there any foods you cannot eat? |
No Yes |
| English Level |
Beginner Intermediate Advanced |
| Level of education completed |
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| What is your major area of study? |
|
| What will your visa status in Canada be during your course of study? |
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| What are your hobbies and interests? |
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| Homestay start date |
day month year |
| Do you require airport pickup? |
No Yes
Flight Details:
Arrival Date
Flight Number
Arrival Time
Arrival Airport
|
| Do you require airport drop off? |
No Yes
Flight Details:
Departure Date
Flight Number
Departure Time
Departure Airport
|
| You will be contacted for payment and other information upon the receipt of this form by the VIA Team. |
