RESIDENCE PARTNER FORM

Your Information

Host Parent Information

Home Parent 1

First Name*

Last Name*

Phone Number*

Email Address*

Gender*

Male Female

Occupation*

Date of Birth*

Host Parent Information

Home Parent 2

First Name*

Last Name*

Phone Number*

Email Address*

Gender*

Date Of Birth*

Address Information

House Number*

Suite House/Number*

STREET ADDRESS*

City*

Province State*

Country*

Family Information

Please list all other people currently living in the home:

Complete Name*

Relation*

Gender*

Date Of Birth*

Complete Name*

Relation*

Gender*

Date Of Birth*

Will there be any visitors/international students/room and board to your home during your students stay? If so, please list:

Complete Name*

Relation to the host*

Age*

Gender*

Length Of Stay*

Complete Name*

Relation to the host*

Gender*

Age*

Home Information

What is the style of your home? Describe briefly.*

Home Information Street Address*

Home Information Country*

Do you have any pets*

Yes No

If YES, please list..

Number of Cats

Breed of Cats

Indoor Cats

Outdoor Cats

Number of Dogs

Breed of Dogs

Indoor Dogs

Outdoor Dogs

Number of Other Pets

Breed of Other Pets

Indoor Other Pets

Outdoor Other Pets

Home Photo

Please provide some photos of the host family and the exterior of the home. We encourage you to get creative with your photo collage, but please keep in mind the collage requires the following:

A minimum of 4 photos
Photos must be of good quality and a decent size - they should be clear, crisp, and visible; not blurry or distorted.
A description for each photo (tell us names of who/what is in the photo, what you are doing, where you are - anything you think is important!)
Photos must be contained in a document (multiple pages is ok!) so it is easy for us to send the collage along to your potential host family. We’ve found that an easy way to put the collage together is to use Microsoft Word or a similar program to paste photos and descriptions in.

Select File

Max number of files : 1

Max File Upload size of each file : 1 MB

Select File

Max number of files : 1

Max File Upload size of each file : 1 MB

Select File

Max number of files : 1

Max File Upload size of each file : 1 MB

Select File

Max number of files : 1

Max File Upload size of each file : 1 MB

YOUR SIGNATURE*

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