Becoming a Homestay Family Form

If you have any difficulties in completing this form, please contact us by e-mail: info@emcicanada.com

Please Note:  ALL fields are REQUIRED. Only COMPLETED application forms can be submitted. This Application Form should take approximately 20-25 minutes to complete.

DO NOT close your browser or your Application will be incomplete.

Please provide accurate information for the following fields:

Family Name:      X
Wife/Partner Name:      X (If none, please type none.)
Wife/Partner Birth Place:      X (If none, please type none.)
Wife/Partner Birth Date:     X (mm/dd/yyyy) (include /)
Husband/Partner Name:      X (If none, please type none.)
Husband Birth Place:      X (If none, please type none.)
Husband/Partner Birth Date:  

  X (mm/dd/yyyy) (include /)
E-mail Address:     X
Address:     X
Address (Cont.):  
City:     X
Province:  
Postal Code:     X (A9A9A9) No Spaces
Rent/Own?     X
Home Phone #:     X (604-999-9999) (Include Dashes)
Alternate Phone #:   (604-999-9999) (Include Dashes)
Wife/Partner Occupation:   If none, please type none.
Wife/Partner Work Phone #:   (604-999-9999)
Husband/Partner Occupation:   If none, please type none.
Husband/Partner Work Phone #:   (604-999-9999)
If you were NOT born in Canada, how many years have you lived here:

Please list ALL languages spoken in your home besides English:

How many children do you have?  
1st child Name and Gender:   (i.e.: Mike, male)
1st Child Birth date:   (mm/dd/yyyy)
2nd child Name and Gender:   (i.e.: Mike, male)
2nd Child Birth date:   (mm/dd/yyyy)
3rd child Name and Gender:   (i.e.: Mike, male)
3rd Child Birth date:   (mm/dd/yyyy)
Do they live at home?  
Does anyone else live in this home?  

If yes, please provide details:

Do you have any pets?     X

If yes, please provide details:

How many private bedrooms available to students do you have?     X

Please provide a list of items that students have access to and any other relevant information:

Will you host...
Females?      X
Males?  

   X
Children (7 to 12)?      X
Teenagers (13 to 19)?      X
Students between the ages of 19 and 29?      X
Older students? (30 and over)  

   X
Are you a vegetarian?  

Will you host a vegetarian?     X
Does anyone in your house smoke?     X
Will you host a smoker?     X
If yes, please provide details where smoking is allowed:

Have you ever hosted an ESL student?  

   X
Are you hosting a student right now?      X

If the answer is yes to any of the previous 2 questions, please list the Homestay companies you have dealt with:

What time is breakfast in your home?  
What time is dinner in your home?  

What type of activities do you do as a family?  X

Please provide detailed bus route information from your home to Burrard Sky Train Station:  X

 

How far is the nearest bus stop to your home?  X

What is the nearest intersection to your home?  X