The London Language Institute Data Protection Policy

Primary Applicant:

Name(Required)

First Last

Email(Required)

Cell Phone(Required)

Occupation(Required)

Date of Birth(Required)

First Language

Have you hosted international students in the past?

Yes

No

Are you currently listed as a homestay for other organizations?

Yes

No

If you were referred by another homestay, please provide his/her name:

Second Applicant:

Name

First Last

Email

Cell Phone

Occupation

Date of Birth

First Language

Languages Spoken

Information About Your Home:

Address(Required)

Street Address Address Line 2 City Province Postal Code

Telephone Number (land line)

Type of Dwelling

Carpeting

Number of Bedrooms In The Home

Number of Full Washrooms in the Home

Number of Half Bathrooms in the Home

Air-Conditioning?

Yes

No

Wifi available?

Yes

No

Number of Bedrooms Available For Homestay Students

Do you have a vehicle?

Yes

No

Additional Information

Information for Student Bedroom 1:

Size of Bed

Location in Home

Furniture in Room

Desk/Chair

Closet

Light Fixture/Lamp

Dresser

Size of Room

Is there a private washroom available for this room?

Yes

No

Does the room have a window?

Yes

No

Additional Information

Information for Student Bedroom 2:

Size of Bed

Location in Home

Furniture in Room

Desk/Chair

Closet

Light Fixture/Lamp

Dresser

Size of Room

Is there a private washroom available for this room?

Yes

No

Does the room have a window?

Yes

No

Additional Information

Information for Student Bedroom 3:

Size of Bed

Location in Home

Furniture in Room

Desk/Chair

Closet

Light Fixture/Lamp

Dresser

Size of Room

Is there a private washroom available for this room?

Yes

No

Does the room have a window?

Yes

No

Aditional Information

Information for Student Bedroom 4:

Size of Bed

Location in Home

Furniture in Room

Desk/Chair

Closet

Light Fixture/Lamp

Dresser

Size of Room

Is there a private washroom available for this room?

Yes

No

Does the room have a window?

Yes

No

Aditional Information

Information About Your Family:

Relationship Status

Do you have children under the age of 18?

Children Information

Are there other adults living in the home?

Information About Adults

Name

Gender

Relationship

Are there currently any international students living in your home?

Information About Students

Do You Have Any Pets In The Home?

Yes

No

Information About Pets

Smoking Habits

Languages Spoken in the Home

Dietary Practices In The Home

Hobbies/Interests

Cultural Exposure

Religious Affiliations/Practices

Additional Information

Preferences for Homestay Students:

What gender of student(s) are you willing to host?

Are you willing to host a couple?

What ages of students are you willing to host?

14 and under

15-17

18+

Are you willing to host a student that smokes cigarettes?

Are there any countries/cultures/religions you are not willing to host students from?

Country/Culture Restrictions

Which dietary restrictions are you willing to accommodate?

Please indicate the times of year you are able to host students e.g year round etc

Please indicate the duration of time you are able to host students for

Short-Term (1-2 months)

Average Term (3-6 months)

Long-Term (6 or more months)

Reference 1

Reference 2

Reference 3

Home Stay Host Application Form

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