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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)
Husband/Partner Name:     X (If none, please type none.)
Husband Birth Place:     X (If none, please type none.)
Wife/Partner Birth Date:  

X (mm/dd/yyyy)


E-mail Address:     X

Address:     X
Address (Cont.):  
City:     X
Province:  
Postal Code:     X (A9A9A9)
Rent/Own?     X

Home Phone #:     X (604-999-9999)
Alternate Phone #:   (604-999-9999)

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?     X
1st child Name and Gender:   (i.e.: Mike, male)
1st Child Birth date:   X (mm/dd/yyyy)
2nd child Name and Gender:   (i.e.: Mike, male)
2nd Child Birth date:   X (mm/dd/yyyy)
3rd child Name and Gender:   (i.e.: Mike, male)
3rd Child Birth date:   X (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?  

  X

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?     X
What time is dinner in your home?     X

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

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