Homestay Application Form | Four Corners Language Institute

Grammar Tip

When writing a date that uses the month, day and year, a comma is used between the day and the year. My cousin’s birthday is January 1, 2005.

Testimonials

"All of the staff and teachers in FCLI are very much friendly and helpful. This is one reason why I choose this school. I am feeling comfortable to study here."

--Yuki

Homestay Application Form

Personal Information

Title: *

First Name: *

Family Name: *

Email Address: *

Date of Birth: *

Nationality: *

Occupation:

Home Address

Street Address: *

City: *

Province / State: *

Country: *

Postal Code: *

Phone Number: *

Fax Number:

Emergency Contact Person

Name:

Relationship:

Telephone:

Home Stay Information

Homestay Start Date: *

Homestay Finish Date: *

Do you require Airport Pick-Up?: *

(Included in Homestay Placement Fee)

Arrival Information

Date:

Arrival Time:

Flight Number:

English Level

Your English Level: *

Personal Details

Do you smoke?:

Do you you prefer a family with children?:

Comments:

Do you you prefer a family with pets?:

Comments:

Do you have allergies to cats?:

Do you have allergies to dogs?:

Do you have other allergies?:

If yes, please describe:

Do you have medical insurance?:

What are your hobbies and interests?:

What are you looking for in a host family?:

Have you traveled overseas before?:

If yes, where?:

How would a good friend describe you?:

(independent, outgoing, shy, talkative, etc)

Four Corners Language Institute (Email Us)

#201-1111 Blanshard St., Victoria, BC, Canada V8W 2H7
Tel: 1-(250) 383-6719 - Fax: 1-(250) 383-6721

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