Student Application
At Arizona Homestay, we do our best to make sure we match you with the best host home. It is very important that you include all the information below so that we can find the right host for you. Please call us with any questions. We are happy to help. Thank you!
Will you be attending: *
Required
Family Name *
Your answer
First *
Your answer
Middle *
Your answer
Email address *
Your answer
Age *
Your answer
Date of birth *
MM
/
DD
/
YYYY
When do you want to start homestay?
MM
/
DD
/
YYYY
Current address *
With City - Country - State/Province
Your answer
Nationality
Your answer
Language spoken *
Your answer
Secondary language spoken
Your answer
Phone # *
(please make sure you have a local number in the US
Your answer
Gender *
Religion *
Your answer
What college will you be attending? *
Your answer
When does your class session start? *
MM
/
DD
/
YYYY
What are you studying?
Your answer
How long will you need homestay? *
What is your student VISA # if you have it
Your answer
Passport #
Your answer
What is your flight number?
Your answer
Airline?
Your answer
Flight arrival time
Your answer
Date of Arrival? *
MM
/
DD
/
YYYY
Will you have a car while in the US? *
Why do you want homestay? *
Your answer
Parent or Agent names
Your answer
Parents or Agent email
please include contact email address
Your answer
Parent or Agent phone
Your answer
Emergency Contact name and phone number *
Your answer
English level *
Interests and hobbies? *
Your answer
Have you studied in the United States before? *
Have you been in Homestay before? *
Will you live in a home with small children? *
Will you be needing meals during homestay? *
Do you have a special diet/food requirements? *
Your answer
Do you drink alcohol? *
Do you Smoke? *
Many Americans to have pets. Can you live in a home with Cats or Dogs? *
Describe your personality? *
(Quiet, outgoing, social, serious)
Your answer
What do you want your homestay family to know? *
Your answer
What are the 2 most important things you want in homestay? *
Your answer
Please list any dietary restrictions, allergies or medical problems you have. *
Your answer
How did you hear about Arizona Homestay? *
How will you be paying for Homestay? Credit card, cash, bank transfer, etc.? *
Your answer
I certify that the above information is correct to the best of my knowledge. If provided information is shown to be incorrect, the application will be null and void and above applicant will not be able to stay with an Arizona Homestay host. By signing the application electronically, I authorized Arizona Homestay to verify the above information.
Signature. *
(Type Name)
Your answer
Date *
MM
/
DD
/
YYYY
Please note that the application will not be processed until the Application and placement fees are paid in full. Thank you. You can pay on the website or we will send you an invoice.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.