HOMESTAY APPLICATION FORM
Name
Gender
M
F
Nationality
Date of birth
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Address
Telephone
E-mail address
Occupation/School(major) in your country
Length of stay in Canada
From
2004
2005
2006
2007
2008
2009
2010
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
to
2004
2005
2006
2007
2008
2009
2010
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
How long would you like to
stay at a homestay
From
2004
2005
2006
2007
2008
2009
2010
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
to
2004
2005
2006
2007
2008
2009
2010
1
2
3
4
5
6
7
8
9
10
11
12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Do you speak any
other languages?
Yes
No
Do you smoke?
Yes
No
Do you drink?
Yes
No
Do you have any allergies
to animals?
Yes
No
Would you like to
stay with pets?
Yes
No
Are you a vegetarian?
Yes
No
Would you like to stay
with small children?
Yes
No
Would you like to stay with a
homestay mate(s) (other
nationality)?
Yes
No
What do you like to do on the weekend?
What would you like to do in Canada?
How would you describe yourself?
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