Fillable HOMESTAY APPLICATION FOR STUDENTS (College of the Rockies)

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HOMESTAY APPLICATION FOR STUDENTS (College of the Rockies)

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Country of origin: CANADA
File type: PDF

Canada forms for College of the Rockies

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HOMESTAY, INTERNATIONAL EDUCATION
2700 College Way, Cranbrook, British Columbia, Canada V1C 5L7
250-489-8248 | homestay@cotr.bc.ca
Page 1
HOMESTAY APPLICATION FOR STUDENTS
Thank you for your interest in the College of the Rockies Homestay Program. Homestay offers international students the
opportunity to live with and share in the daily life of a Canadian family while studying at COTR. Students who have an open
mind and a willingness to accept the responsibilities of being a homestay student, will find homestay a rewarding experience.
Please ensure that this application is completed fully and accurately so that we can best match you with a suitable Canadian
family. Personal information on this form will be shared with homestay hosts when finalizing homestay placement.
Please submit your completed Application and Homestay Agreement by email to homestay@cotr.bc.ca
at least two months
before the semester begins. In addition, please send your arrival information (flight itinerary) as soon as you have it. You will
receive detailed information about your homestay family approximately 3-4 weeks before the semester begins.
STUDENT INFORMATION
Student Family Name: ______________________________ Student Given Name:_____________________________
What name would you like to be called? _______________________ Student Number: ________________________
Date of Birth (Year/Month/Day): _____________________ Email Address: ___________________________________
Nationality: ________________ First Language: _________________ Additional Languages: ______________________
I identify my gender as: ☐ Male ☐ Female ☐ Non-binary/Other
List all family members below:
Name Relationship Age Occupation/Study
1.
2.
3.
4.
5.
6.
List any pets:
EDUCATION CONSULTANT/ AGENT INFORMATION (IF APPLICABLE)
Name of agent: ___________________________________ Contact Name: ________________________________
Email address: ____________________________________ Telephone: ___________________________________
Do you give us permission to share placement information with your agent? ☐ Yes ☐ No
HOMESTAY, INTERNATIONAL EDUCATION
2700 College Way, Cranbrook, British Columbia, Canada V1C 5L7
250-489-8248 | homestay@cotr.bc.ca
Page 2
PROGRAM OF STUDY Program Name: __________________________________________________________________
Start Date (month/year): ____________________________ Expected end date (month/year): __________________
Do you plan to be with a host family for the full length of your program? ☐ Yes ☐ No
If no, approximately how long do you plan to be with a host family? __________________________________________
HO
MESTAY PREFERENCES
The following information will be used to assist in matching you with a homestay family, but it is important for you to
understand that we cannot guarantee that your homestay family will meet all your preferences.
Please mark all boxes that apply:
1. FAMILY AGE:
☐ Young ☐ Middle-aged
☐ Older ☐ No preference
2. CHILDREN:
☐ Family with children ☐ Family without children ☐ No preference
If you indicate that you would like to live with a famiy with children, please complete the following:
Children age 0 to 5 years are
acceptable: ☐ Yes ☐ No
Children age 5 to 13 years are
acceptable: ☐ Yes ☐ No
Children over 14 years are
acceptable: ☐ Yes ☐ No
3. PETS: ☐ No pets
☐ No dogs ☐ No cats ☐ No birds ☐ I love pets
Are you allergic to dogs? ☐ Yes ☐ No Are you allergic to cats? ☐ Yes ☐ No
4. HOUSEHOLD
RESPONSIBILITIES:
Can you cook for yourself when necessary? ☐ Yes ☐ No
Do you know how to do laundry? ☐ Yes ☐ No
5. ACCESSIBILITY: Do you have any accessibility needs Homestay should be aware of? ☐ Yes ☐ No
If yes, please explain:
More About You
Choose One:
If yes, please specify:
1.
Do you practice a religion?
Yes
No
2.
Do you have any illnesses?
Yes
No
3.
Do you have any allergies?
Yes
No
4.
Do you take any medication?
Yes
No
5.
Do you smoke or vape (e-cigarettes)?
Yes
No
6.
Do you require a special diet?
Yes
No
7.
What foods do you avoid (not eat)?
8.
What foods do you like to eat?
HOMESTAY, INTERNATIONAL EDUCATION
2700 College Way, Cranbrook, British Columbia, Canada V1C 5L7
250-489-8248 | homestay@cotr.bc.ca
Page 3
ADDITIONAL INFORMATION
English speaking ability: ☐ Good ☐ Fair ☐ Poor ☐ Very Poor
What are your hobbies and interests? __________________________________________________________________
Have you travelled abroad before?
☐ Yes ☐ No
If yes, where and for how long? _____________________________________________________________________________
Which of these personality traits best describe you? Choose five words.
☐ Sociable ☐ Shy ☐ Responsible ☐ Cheerful ☐ Quiet
☐
Studious
☐ Lazy ☐ Calm ☐ Athletic ☐ Friendly ☐ Adaptable ☐ Outgoing
☐ Fun-loving ☐ Agreeable ☐ Adventurous ☐ Anxious
☐
Serious ☐ Tidy
☐ Messy ☐ Organized ☐ Artistic ☐ Confident ☐ Independent ☐ Energetic
IN
TRODUCTION in English, please write an introductory letter to your host family. This letter should tell your family a
little about your interests, food preferences, your English ability (strengths and weaknesses), and personal goals for your
time in Cranbrook.
HOMESTAY, INTERNATIONAL EDUCATION
2700 College Way, Cranbrook, British Columbia, Canada V1C 5L7
250-489-8248 | homestay@cotr.bc.ca
Page 4
Signature
PRINT Last name, First name
Signature Date
EMERGENCY CONTACT INFORMATION
Who should we contact in case of an emergency (serious injury, illness, etc.)?
Primary Contact:
Name: __________________________________________________ Relationship: ____________________________
Country: ______________ Phone Number: _________________________ Email: _______________________________
Secondary Contact:
Name: __________________________________________________ Relationship: ____________________________
Country: ______________ Phone Number: _________________________ Email: _______________________________
S
IGNATURE(S)
By signing below, I confirm that the information provided is true and complete to the best of my knowledge.
Student: ____________________________________________ Date: ____________________________
I
n the case of minor students (under 19 years of age), the student’s parent or guardian must also agree to the terms and
conditions of this agreement.
By signing below, I confirm that the information provided is true and complete to the best of my knowledge.
Parent and/or Guardian (if applicable): _____________________ ____________________________ ______________
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HOMESTAY APPLICATION FOR STUDENTS (College of the Rockies)

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Completed 5 February 2021

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