FOA STUDENT HOMESTAY APPLICATION
We are excited to get to know you!
First Name
Last Name
Check in Date:
Check out Date:
Age
Date of Birth
Gender
Male
Female
Other
Address
Phone Number
Email
Passport or Drivers license or ID number
Emergency Contact Information
Please fill in the details below of who we can contact during an emergency
First Name
Last Name
Relationship
Address
Phone Number
Email
Medical Infomration
Please describe below your medical needs
Please list your allergies (Animals, Food, Others)
Please describe your medical or health (mental) condition which your host family should be notified.
Do you take medication? If so please list the medication you take.
Do you smoke?
Select an option
Yes
No
If you smoke do you agree to not smoke in or around the host's home?
Yes
No
I understand and agree if I am caught smoking in or around the host family's home, I will be asked to leave the homestay who does not allow smoking at their home.
Yes
No I don't agree
Do you drink Alcohol? If over the age 21
Yes
No
If you drink alcohol do you agree to not drink at host family's home if not allowed?
Yes
No
Transportation needs
Please review options below
Do you need airport transportation to your host family house? $125 per trip or $225 round trip/2 trips
Select an option
No
Yes
$250 One-Way or $350 round trip
Do you need daily transportation by host family? ($25 a day) Not garenteed
Select an option
Yes
No
Are you able to take bus?
Select an option
Yes
No
If you take the bus what is your bus details
Will you have a car in the US? If YES, what kind of car do you have?
Lets get do know more about who you are as a person
Please describe below more details
Do you have a special religion?
Select an option
Yes
No
Rather not say
If YES what religion do you follow?
Are you attending school? If YES please state which schools your attending.
What do you major at your school?
Do you have work? If YES please state where you work.
What is your English ability?
Excellent
Good
Fair
Little
Do you speak another language? If YES, please list the Languages you speak.
Have you lived in a homestay before? If YES, please explain.
What are your hobbies and interests?
Please describe your family life at home. Do you have siblings? What do you like to do in your free time?
What kind of Homestay are you requesting?
Please answer the questions below.
Homestay placement fee includes room and board and two meals a day per night (breakfast/dinner/+lunch on the weekends and holidays) Plus, we have a ONE-TIME service charge of $400 for homestay placement for up to 6 months. After 6 months if the student continues the homestay program, there will only be a $325 placement fee. Please note if a student requests to change host family during the agreed stay, there will be an additional placement fee for each request.
Please select which Homestay fee applies to your stay?
Single placement/ Less than 6 days at $60 an night
Single placement/ 7 Nights or more at $55
Double placement/ Less than 6 days at $45 an night
Double placement/ 7 Nights or more at $45
What is your Bedroom preference?
Your own bedroom/1 bed
Shared bedroom/ 2 beds in each room
No preference
How many meals a day? Breakfast, Lunch, and Dinner
1 meal
2 meal
3 meal
I agree to pay a one time fee of $400 (non refundable after placement)
Yes
No
Do you mind pets?
Yes
No
No preference
Are Children ok in the homestay?
Yes
No
No preference
Any special request or message to your host family (Self Introduction)
I understand and accept all above aggreements
Your Signature
*
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