For how long do you want to receive a foreign student? 
 2 weeks     1 month    More

Which month(s)? 

Preferred nationality: 

HOST FAMILY INFORMATION


PARENTS

Last name:

Mother’s first name: 

Father’s first name:

Married

Common-Law

Divorced

Separated

Widowed

Single

Address:

 City: 

Province:

 Postal code: 

Home tel:

Father’s age:  

 Occupation: 

 Tel: 

Mother’s age: 

 Occupation: 

 Tel: 

E-mail: 

CHILDREN

First name:

Sex:

Birthdate (D/M/Y):

At home?

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

FAMILY'S INTERESTS    
Activities: 1 Favourite   2 Regularly   3 Occasionally   4 Not at all

1

2

3

4

1

2

3

4

 Swimming

 Shopping

 Sailing/Boating

 Photography

 Windsurfing

 Video games

 Fishing

 Computers

 Tennis

 Chess

 Golf

 Collecting:  

 Horseback riding

 Movies

 Soccer

 Theater

 Cycling

 Classical music

 Basketball

 Modern music

 Baseball/Softball

 Dance

 Mountaineering

 Concerts

 Jogging

 Museums

 Camping

 Reading

 Gymnastics

 Painting/drawing

 Cooking

 Musical instrument: 

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

2. Will your student have opportunities to meet teenagers?

3. Is smoking allowed?

 Yes

 Outdoors only

 No

4.

 Do you have a religious affiliation?  If yes, thanks for indicating which one:

5. Do you attend church?

 regularly

 occasionally

 rarely

6. Where do you live?

 on a ranch

 in a rural area

 in a small city
 (50,000-250,000)

 on a farm

 in a town
 (5,000-50,000)

 in or near a large city
 (+250,000)

7. 

Do you have pets at home?  If so, please indicate which ones:

8.

If anyone belongs to a club, an organization or a team, please indicate which one and the name(s) of the family member(s) concerned:

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