Homestay Host Application

Guidelines

Please supply all information requested. Except for the specific, limited uses indicated in this form, all information that you supply will be kept strictly confidential.

Host Information

Name of Applicant

Last Name: *

First Name: *

Date of Birth: *

E-mail: *

Telephone: *

Have you hosted an international student before? *

If yes, please give detail: *

Home Address:

Street: *

City: *

Province: *

Postal Code: *

Children/Other Residents Living at Home:

Resident 1:

Name:

Gender

Date of Birth

Day

Month

Year

Relationship:

Resident 2:

Name:

Gender

Date of Birth

Day

Month

Year

Relationship:

Resident 3:

Name:

Gender

Date of Birth

Day

Month

Year

Relationship:

Do you have Internet access? *

Do you have internet access in your home? *

Do you have a washer and dryer in the home that a student can access to wash their clothing? *

Do you plan on hosting a student from another homestay program at the same time? *

If yes, please provide further detail: *

The student would have a: *

Do you have pets in your home? *

If yes, please list: *

Are there any musical instruments or sports equipment in the home that your homestay student can access? *

If yes, please list: *

Home Information

Bedrooms Available: *

Bathrooms Available: *

Type of Dwelling *

Please Specify: *

Do you have smoke detectors and carbon monoxide detectors on each level of your home? *

Do you have a fire extinguisher installed in your home? *

Do you have a bus stop near your home? *

*Students must be able to commute to Lakehead University by bus in 45 minutes or less.

Hosting Information

Preference *

Would you accept a married couple? *

How many students would you like to host? *

Would you accommodate a student who smokes? *

Would you prefer to: *

Lifestyle Information

How would you describe your family and family’s lifestyle? *

What languages are spoken at home? *

Does your family have any special dietary practices/restrictions/allergies? *

Please List: *

Describe your family’s leisure activities and community involvement. What type of activities would you offer to the student?

Do you, or your family; observe any religious traditions in your home? If so, which religion do you observe?

References

Please provide 2 references (not relatives)

Reference 1

Full Name: *

Relationship: *

E-Mail: *

Phone: *

Reference 2

Full Name: *

Relationship: *

E-Mail: *

Phone: *

Please Read *

By clicking this checkbox:

I/We declare that all the information provided in this application is accurate and understand that any inaccurate information may invalidate this application. I/We agree to submit a criminal record check for each household member over the age of 18. I/We understand that the Homestay Host application is not complete until the Lakehead University English Language Centre receives all criminal record checks. Please be in touch via email to international.homestay@lakeheadu.ca with any questions or concerns. Thank you for your application!