To print this application, use your browser's print option.  Then use a pen to clearly print all the information requested below.

Fill out this application ONLY if you wish to stay with a family.
 

Please note the following important information:

a) Enclose with this application a non-refundable $150.00 homestay placement fee and two recent photos

b)  INTERLINK must receive this application 4-8 weeks before your arrival.

c)  The homestay cost is approximately $600 each month, depending on location.

d)  Upon arrival, you will be required to pay a $300 deposit. This deposit will be refunded if you leave the home with a two-week advance notice and if there are no outstanding charges, such as telephone bill.

e)  If your plans change or you cannot come on the date for which you have registered, notify us immediately.

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Check the campus you wish to attend: ___CSM     ___ISU   ___VU   

 1.     Name: _________________________   _______________________
                    Family name                                  First name

  2.     Sex: ___ Male    ___ Female

 3.     Address:

       __________________________________________________________________
       Street Address or P.O. Box

       __________________________________________________________________
       Postal code/City/Country

 4.     Date of Birth:   ___________________
                                    Day / Month / Year

 5.     Nationality:   _______________________

 6.     Native language: ___________________

 7.     Your English conversational ability (Circle one):

        Very good           Good           Fair      Poor      None

 8.     Level of education completed:

        (    ) secondary
        (    ) university
        (    ) post graduate

 9.     What is your present or future occupation?   __________________

10.     How long will you stay with your host family?  (Circle one)

                1 term             2 terms            more than 2 terms

11.     Do you have a religious preference?   _________________________

12.     Please check the appropriate box:

        Do you wish to stay with a family that: (preferences cannot always be accommodated)

          has small children?     ___ Yes    ___ No  ___ No Preference
          has a dog?                 ___ Yes    ___ No  ___ No Preference
          has a cat?                  ___ Yes    ___ No  ___ No Preference
          smokes?                    ___ Yes    ___ No  ___ No Preference

13.     Do you smoke?   ___ Yes   ___ No

14.     Do you drink alcoholic beverages?  ___ Yes   ___ No

15.     Please list any foods that you cannot eat or allergies or medical problems that you may have

_________________________________________________________________

_________________________________________________________________

16.      If you have any difficulties walking or other physical conditions that your homestay family should know about, please describe:

________________________________________________________________

_________________________________________________________________

17.     Person to contact in an emergency:

          Name: __________________________________________________________

          Phone:__________________________________________________________

18.     On a separate sheet of paper, please tell your host family about yourself, your hobbies, interests, plans, etc.

         __________________________         __________________________
         Signature of applicant                            Signature of Parent or Guardian
         __________________________
         Date