HOMESTAY APPLICATION
Please note the following important information:
A non-refundable $150 homestay application fee is required along with the application form.
INTERLINK must receive this application 4-8 weeks before your arrival.
The homestay cost which includes room and board is approximately $600 each
month, depending on location.
Upon arrival, you will be required to pay a $300 deposit. This deposit will be refunded if you leave the home with a two-week advance notice and if there are no outstanding charges, such as telephone bills.
If your plans change or you cannot come on the date for which you have registered, notify us immediately.
Please type all the information requested below. When you are finished, click on "Submit" below.
1. Indicate which center are you applying to:
Colorado School of Mines
Indiana State University
University of North Carolina G
Valparaiso University
2. Indicate when you want the homestay to begin: term
Spring 1
Spring 2
Summer
Fall 1
Fall 2
year
2010
2011
2012
3. Method of payment of placement fees:
Bank transfer
Check sent by mail
Visa or Mastercard by mail or fax
MoneyGram
Western Union
4. Family Name:
First Name:
Mailing Address:
City:
Country:
State/Province:
Phone Number:
Email:
Date of Birth:
Country of Citizenship:
Native Language:
Present/Future Occupation:
How long do you plan to stay with your host family?
weeks
EDUCATIONAL BACKGROUND
5. Highest educational level completed:
Secondary
University
Post Graduate
6. Please rate your English conversational ability:
very good
good
fair
poor
FAMILY PREFERENCES
7. Will you be able and willing to stay with a family that: (preferences
cannot
always be accommodated)
has small children?
yes
no
no preference
has a cat?
yes
no
no preference
has a dog?
yes
no
no preference
smokes?
yes
no
no preference
8. Please indicate all that apply to you:
Male
Female
Drink alcoholic beverages
Do not drink alcoholic beverages
Smoker
Non-smoker
9. Do you have any allergies or medical problems or are there any foods you cannot eat?
Yes
No
If yes, please explain:
10. Do you have any difficulties walking or other physical conditions that your homestay family should know about?
Yes
No
If yes, please describe:
11. What are your hobbies and interests?
EMERGENCY CONTACT PERSON
12. Full Name:
Address:
Phone Number:
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