Are you willing to walk to campus? Yes No
Do you expect transportation to campus? Yes No
Gender:
Male Female
First Name:
Homestay Program - Student Application
351 West University Blvd. COC Cedar City, UT 84720
435.865.8198 homestay@suu.edu
Date Prepared:
Have you attended another college or university before SUU? Yes No
If so, please include the name of the institution and how long you attended.
HomestayApp_EH213
Thank you for choosing the SUU Homestay Program as your housing option. Please fi ll-out every fi eld below with complete and
accurate information. If a question does not apply to you please enter the word “None” into the answer fi eld. Every fi eld must
be fi lled in, in order for the application to be offi cially submitted. If you have more details than space provides, please attach
information on an additional page.
SUU Student ID (T-number):
Personal Email Address:
Other Names Used:
Date of Birth (MM/DD/YYYY):
Last (Family Name):
What is your home country?
College/University:
Starting & Ending Dates (MM/YY):
/ to /
College/University:
How many years of English Language courses have you
taken?
Do you have any dietary needs, allergies or cultural restrictions?
Do you practice any religion or attend religious services regularly? Yes No
If so, please indicate the religion and when you like to attend services?
Please indicate which SUU term(s) you would like to reserve
a homestay:
Spring 1 Spring 2
Summer 1 Summer 2
Fall 1 Fall 2
Do you have any pet allergies or fears? Yes No
If so, please indicate what type of animal(s)?
Starting & Ending Dates (MM/YY):
/ to /
Do you have any special medical or physical needs? If so, please describe them below:
Page 1 of 2
Do you smoke? Yes No
