HOMESTAY/ROOMSTAY APPLICATION FORM

STUDENT NAME: ______

We believe your choice of accommodation is important to your success in Canada.

Homestay/Roomstay:

Students who choose Homestay/Roomstay should complete and submit this application form,and must commit to a full term.

Your Homestay family will provide 3 meals a day. In Homestay, it is expected that you will assist the family in preparing your breakfast and lunch.

Your Roomstayfamily will not provide meals – you are required to buy and cook your own food.

Please make your selection below:

Homestay (includes all food) - $29.00 CAD per day ______

Roomstay (you must buy and cook your own food) - $18.00 CAD per day ______

Placement:

Applications for Homestay/Roomstay are completed on a first-come first-serve basis and subject to availability. The deadline for Homestay/Roomstay placements is 3 weeks before your arrival at CultureWorks. Upon receipt of your arrival information, you will receive an invoice that MUST be paid 12 weeks before your arrival. The invoice will include a daily rate (see above), placement fee ($225.00 CAD), tuition and airport reception (if requested).

Cancellation:

Should you decide to move out before the term is over, you will not receive a refund. At the end of the term, you will have the option to stay with your current host family, ask to be moved to a different host family or move out on your own.

Host Families:

Our host families are chosen based on a written application and lengthy interview process. All of our families look forward to having students in their home. Some of our host families are close to the school and some are not. We believe the quality of the family is more important than the distance to the school (we will not change your Homestay/Roomstay because of distance from the school). In both Homestay and Roomstay, you may be expected to assist the family with light daily chores, especially keeping your bedroom clean.

Application Details: Please indicate your preferences below and we will try our best to meet your requirements.

Describe yourself, checking all applicable terms:

( ) shy( ) intellectual( ) quiet

( ) talkative( ) emotional( ) sociable

( ) scientific( ) artistic( ) athletic

( ) studious( ) thoughtful( ) energetic

Most host families in Canada keep pets.

Do you like animals? ( ) Yes( ) No

Are you afraid of animals? ( ) Yes – If yes, which animal?( ) No

______

Do you smoke? ( ) Yes( ) No

Note: You will only be allowed to smoke outside and not in your room or the house.

If available, I prefer a family:

with pets / with no pets / does not matter
with no children / with children under age of 10 / with children over age of 10
who are busy / who are home most evenings / does not matter
who do not smoke / does not matter

I would preferto live in a home with other students:

( )yes( ) no( ) does not matter

And who will speak my language

( ) yes( ) no( ) does not matter

All students studying on campus require medical insurance. Please order medical insurance for me:

( ) Yes( ) No (I will provide my own)

Do you have a medical issue or health concern that you would like your hosts to know about?

______

______

Do you have any food allergies?( ) Yes( ) No

If yes, please list the foods you are allergic to:

______

______

Please tell us anything else you think is important:

______

______

Student SignatureDate

(Dec/11)