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Home Address:
Street Address or P.O. Box
City
State/Department/Province
Postal Code
Country
Telephone
Fax
Homestay Start Date: Circle One Homestay Option: Personal Preferences: Does not have pets Does not have children Single Room Twin Room
MALE
FEMALE
Has pets ( ) Dog ( ) Cat ( ) Birds Has children ( ) Small Family ( ) Large Family ( ) Infant(s) ( ) Young Children Smokes Allows alcoholic beverages Vegetarian
( ) Teenagers
List any allergies: _____________________________________________________________________ List dislikes [food / animal / other]: ______________________________________________________ Circle the qualities that best describe your personality / character: Active Organized Artistic Outgoing Athletic Positive Curious Quiet ] Family-Oriented Sensitive Shy Humorous Sociable Independent Studious
Religious [Preference:
Please write a letter of introduction in English to your prospective host family. Include information about your family life and daily routine in your home country, along with your educational and professional background, favorite indoor and outdoor activities, sports, movies, music, hobbies, and foods. If you have traveled or studied abroad before, please describe the circumstances and state your impressions. Indicate your personal and educational goals.
[Additional pages may be attached]