Host an international student

If you are interested in hosting an international student, please fill out this form and an MLI Homestay representative will contact you.

Host Parents

Mother

First Name:
Last Name:
Date of Birth:	YYYY/MM/DD
Occupation:
Work Tel:
Email:
Cell Phone:

Father

First Name:
Last Name:
Date of Birth:	YYYY/MM/DD
Occupation:
Work Tel:
Email:
Cell Phone:

Family Information

People living in the home

Please list all people currently living in the home: (including immediate family, international students, boarders,
extended family members etc.)

First Name:	Last Name:	Relation:	Date of Birth: (YYYY/MM/DD)

Home Information

Please Describe Your Home & Surrounding Area:
Home Address:
City:
Province:
Postal Code:
Home Phone:
Style of home:
Number of Bedrooms:
Number of Bathrooms:
Smoking:	Yes No
If so, indoor or outdoor:	Indoor Outdoor

Pets Pets Yes No

If Yes, please list:	Number	Breed	Indoor	Outdoor
Cats
Dogs
Other

Interests & Activites Family Interests include:

Swimming	Reading	History	Drawing	Baseball	Music	Snowboarding
Collecting	Martial Arts	Video Games	Hockey	Biking	Tennis	Horseback Riding
Basketball	Cooking	Theatre	Concerts	Hiking	Soccer	Photography
Shopping	Boating	Movies	Painting	Gardening	Dance	Board Games
Camping	Fishing	Golf	Computer	Walking	Skiing
Other:

School Information

NOTE: School Information section applies to All

Name Of closest Local Elementary School:
Name Of closest Local High School:
Method of Transportation To/From School:	School Bus City Bus Walk
Distance to School (one way, in minutes):

Miscellaneous

How did you hear about our programm?

Why does your family want to host an international student?

Who will be the main companion(s) of your student during their stay?

If you won't have a child at home during the stay, will your student have opportunities to meet other children? If so, where?

Will the main companion be working during the day? Yes No

If so, who will be spending time with your student during working hours?

Preferences

Your family wishes to host: (please indicate all that would be a fit for your family)
Boy Girl Teacher/Chaperone

Would you be willing to host a student of the opposite gender than you requested? Yes No

Other than the programme you were recruited for would you be able to host any other time of the year?
Yes No
Summer Semester Full Year

Additional Information What aspects of your family life/community/area would you look forward to sharing with an international student?

Can anyone in your family converse in another language? Yes No

If yes, which language(s)?

A few students may have dietary restrictions for health or religious reasons (vegetarian, allergies, etc.).
Could your family accommodate these requests? Yes No

Have you hosted before? Yes No

Please feel free to share any additional information about your family that you feel would be helpful.

References

Please list 2 references who know your family very well. MLI and its staff wil be the only people contacting your references.

Name:	Adress:	Phone Number:	Relationship To Hosts: