Student Online Application Form

Student Profile & Application

Personal Details

The dates for which you are applying for Homestay:    
From: To:
Type of Visa entering the United States: 
First Name: Last Name:
Gender: Date of Birth:
Country of Origin:
Home Address (complete):
Student’s Native Language: Primary Language Spoken in your Home:
Student’s Cell Phone: Student’s Email:
Do you smoke? Could you live in a home with someone who smoked (outside)?
Do you have any health problems? If yes, Please specify:
Do you have any allergies to pets?  If yes, Please specify:
Are you taking any medications? If yes, Please specify:
Do you have health insurance that is valid in the USA? If yes, Please specify Company name and Policy #
Emergency Contact: Relationship to Student:
Cell Phone:  Work Phone:
Personal Characteristics:
(please select all that apply)
CautiousEnergeticHumorousIndependentModestQuietShySociable / OutgoingStudiousTalkativeTidy
What type of home do you prefer?
Will you accept living in a home with a family’s other children? Will you accept living in a home with pets?
Would a host family's religious views be a factor in your decision to live with them?  
Would you prefer a TV in your room?  (not always available)
Do you have Special requirements? If yes, Please specify:
What are your hobbies?
Do you have any food allergies? What do you enjoy eating for breakfast?
What do you enjoy eating for dinner? Is there any food that you do NOT enjoy eating?
Would you require transportation to school? Would you be willing to take public bus transportation to school?  (if available)

Travel Details

Airline: Flight #:
USA Connecting Airport to Florida Airport: Florida Arrival Airport:
Florida Arrival Date: 
Florida Arrival Time:

School Details

How did you hear about Homestay Florida’s International Student Program? Have you lived in homestay in the United States before? If yes, then please provide details.
What school will you attend?please select one Other:
What date does school begin?
What are your class hours?
Additional comments:
We expect all of our homestay students to be courteous and respectful while living with our host families. Please provide two character references. These must be personal, non-familial references who have known you for at least five years.
"I verify that the information on this form is true and correct to the best of my knowledge."
Electronic Signature & Date
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