Homestay, ESL Schools, Vancouver Canada, EMCI Canada

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