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Homestay Application
1. Family Name
2. Given Name
3. E-mail Address
4. Have you experienced a Homestay?
Yes
No
4.1. If Yes,Where?
4.2. For how long?
5. Do you smoke?
No
Yes
6. Do you like pets?
Yes
No
Not important
7. Do you have any allergies?
No
Yes
7.1. If Yes, what kind?
8. What type of person are you?
Friendly
Positive
Athletic
Shy
Musical
Artistic
Quiet
Talkative
Independent
Outgoing
Easygoing
Openminded
9. What are some of your hobbies?
10. Please tell us about your family
11. I would prefer my host family to
Have young children
Have teenage children
Have no children
Have pets
Introduce me to family and friends
Be quiet
Be active
Give me privacy
12. Do you have any food dislikes?
13. Do you have any special health conditions?
No
Yes
13.1. If Yes, what are they?
14. Course starting date(month/day/year)
15. Course ending date(month/day/year)
16. Do you want information on other accommodation ?
Yes
No