Find a Homestay

Your Name

Gender

 Female
 Male

Date of Birth

/
/

Where do you live?

Telephone Number

Email Address

Nationality

Example: Chinese

Native Language

Example: Mandarin

Do you smoke?

 Yes
 No

Do you prefer to stay with a family …

 with children
 without children
 no preference (children)
 with pets
 without pets
 no preference (pets)
 smoking family
 non-smoking family
 no preference (smoking)

Do you take any medicine?

If yes, please describe your medications here.

Do you have any allergies?

If yes, please describe your allergies here.

Do you have any disabilities?

Are there any foods you cannot eat?

English skill level

 Beginner
 Intermediate
 Advanced

Level of education completed

Example: Highschool

What is your major area of study

What will your visa status in Canada be during your course of study?

What are your interests and hobbies?

Homestay Start Date

MM/DD/YY — Example: 10/03/12

Do you require airport drop-off?

 Yes
 No

Flight Details

Please complete this part if you require airport pick up.

Arrival Date

MM/DD/YY — Example: 10/03/12

Flight Number

Arrival Time

Example: 13:00

You will be contacted for payment and other information upon the receipt of this form by the VIA Team.

Additional Comments

Please write additional comments or specific requests here…