BELLINGHAM SISTER CITIES ASSOCIATION

HOMESTAY APPLICATION FORM

Please complete all questions. This information will help us find a good host family placement for you.

Name / Date

(last/family) (first/given) (middle initial)

Age     Birthdate     Male/Female

Permanent Address

Phone Number

Number of people in your family?

Please list their names, ages and relationship to you:

Are you a student?
Name of school attending:    
Year in school:
Father’s Name: Occupation:
Mother’s Name: Occupation:

List the countries you have visited:

Language(s) you speak and degree of proficiency:

Hobbies/Interests/Sports:

Occupation/Professional Goals:

Host family preference:
a family with children? If so, what ages?
a family without children? a single host?
an elderly couple? no preference.

Would you mind sharing your room? Yes / No / Perhaps

Dates of your homestay:

Do you smoke?

Many people prohibit smoking in their home. If you smoke, would you consider quitting or smoking outside the home?

Can you live with pets?

If you have any allergies or special medical considerations, please explain:

If you have special medications, please explain:

Favorite foods:

Foods you dislike:

Activities you would like to pursue or places you would especially like to see during your stay:

Attach a page with pictures of yourself, your family, your home, your hobbies and/or other pictures you would like to share with your host family.