HOST
FAMILY APPLICATION
Please Return Completed Form To:
[email protected]
If you are unable to return electronically, please print and return to:
Georgian College International Education and Training
One Georgian Drive
Barrie, ON, Canada
L4M 3X9
Telephone: (705) 728-1968 x1392 Fax: (705) 722-5158
Contact Information:
Full Name:
Last
First
Address:
Street Address
Apartment/Unit #
City
Home Phone:
-
-
Alternate Phone:
Province
- -
Postal Code
E-mail Address:
How long have you lived at this address?
months
years
Do you own the home?
Yes
No
Georgian College Campus:
Are you within walking distance of the campus?
How long would it take students to walk from your home to Georgian College?
How long would it take a student to walk from your home to the closest bus stop?
How long would it take to travel by bus to Georgian College?
Yes
No
Mins
Mins
Mins
Route Number
Accommodation Preferences:
Option 1
Homestay with a Canadian Family (Includes Meals)
This option includes three meals a day. Please note students will usually prepare their own breakfast and lunch (ingredients
provided by the host) and the host will prepare the evening dinner.
Option 2
Homestay with a Canadian Family (Not Including Meals)
Host Family Application Form
HOST
FAMILY APPLICATION
This option requires students to purchase and prepare their own meals. The host must provide access to the kitchen and
space to store food.
Family Information:
Last Name
First Name
Year of
Birth
Gender
Relationship
Occupation
Host
Household Customs & History:
Languages spoken in your home:
Check the hobbies, sports and activities that your family participates in on a regular basis:
Family Dinners
Hiking
Golf
Skiing
Artwork
Music
Watching TV
Gardening
Visiting Relatives
Canoeing
Swimming
Sailing
Computers
Internet
Photography
Camping
Household Chores
Picnics
Jogging
Movies
Reading
Sports Events
Religious Activities
Basketball
Other:
Other:
Other:
Other:
Would you be open to having a student participate in some of these family activities?:
People from other cultures?
Has your family had previous experience with:
Yes
No
Hosting an international student?
Have a religious affiliation?
Yes
No
Does your family:
Attend religious services?
No
Yes
Yes
No
Yes
No
Host Family Application Form
HOST
FAMILY APPLICATION
Accommodation Details:
Number of student rooms available (max. 3)?
Homestay is Available:
If you selected Option 1, please complete the meals information:
Breakfast:
Lunch:
Dinner:
Family
Family
Must be prepared and eaten with the family
Meals:
Prepared
Prepared
usually 4+ nights per week
Choose one of the following options for
OR
OR
each meal of the day.
Self-Serve
Student
Prepared
If requested, my family is willing to adapt to the special dietary needs of a student: Yes
If requested, my family is willing to provide vegetarian meals for a student: Yes
Comments:
No
No
Host Preferences:
Do you have a gender preference?
Do you have any countries of
interest?
Male
Female
No
Preference 1:
Do you or anyone in the home smoke?
Do you have any pets?
Do you have any allergies?
Preference 2:
Yes
Will you host a student who smokes (not in the home)?
Will you host a student who drinks?
No Preference
No
Yes
No
No
Preference 3:
No
Only socially
Small dog
Yes
Large dog
No
Yes
Cat
Other
Seasonal
Why do you want to be a part of the Homestay program?
How did you hear about the Homestay program?
Host Family Application Form
HOST
FAMILY APPLICATION
Homestay Agreement:

Homestay fee includes:
o private bedroom with a bed, desk, dresser, storage for student’s belongings, window with an
unobstructed portion of 3.8 sq. feet and no dimension less than 15”
o access to kitchen and other common areas of the home
o use of utilities (water, electricity, heat, air conditioning)
o internet connection throughout the home and in student’s bedroom
o use of a bathroom either shared or private
o laundry facilities at least once a week
o bed linens and towels
o home must meet fire safety standards
In addition to what the Homestay fee includes, the following plans require:
o
o
Option 1 Homestay with a Canadian Family (includes meals) $750:
 3 well balanced meals a day (this includes a variety of fruits, vegetables, meats, dairy,
grains)
 provide a sit down dinner a minimum of 4 times a week
Option 2 Homestay with a Canadian Family (not including meals) $500:
 the only difference with this plan is that the student will be responsible for purchasing
their own food and preparing their own meals (access to the kitchen and space to put
food in the fridge, cupboard is required)
I agree to offer the following amenities to the student: ________
_______
Initial Here
I agree to attend information sessions on hosting international students held at Georgian College
approximately three times a year?
Yes
No
I/We understand that I/We cannot be guaranteed a student and that there is a 60-day trial period during which I/We or
the student may choose to end the arrangement.
I/We understand that the information collected on this form is used for the administration of the Homestay program
and hereby authorize Georgian College to disclose this information to our Homestay student(s).
Signature (Typed or Signed)
Signature (Typed or Signed)
Date (DD/MM/YY)
Host Family Application Form
HOST
FAMILY APPLICATION
Criminal Record Checks:
In the interest of the health and safety of our international students, it is critical that we
are aware of the following information about those living in your home:
1. Are there any concerns regarding members of the family living in the home that may
impact on students living in your family environment (allergies, mental illness, medical
issues, and addictions)?
Yes
No
If yes, explain:
2. Has anyone in your home been charged with or convicted of an offense related to the
care of minors; an offense of a sexual nature or that would result in being listed in the
database for Pardoned Sex Offenders; an offense related to the use or trafficking of
drugs or an offense of violence or harassment?
Yes
No
If yes, explain:
3. Police Record Checks can be provided for:
Name of Family member
(over 18 years old)
Name (Printed)
Police Check Date
_________________________
Signature
Copy Attached?
Date
According to Canadian law, the personal information we are collecting will be used for administering the Georgian
College Homestay Program. For further information about the information requested on this form or the purpose for
which the information will be used, contact the Homestay Coordinator at 728-1968 extension 1392.
Georgian College is compliant with the Freedom of Information and Protection of Privacy Act (FIPPA) and
endeavours to protect your personal information in compliance with this Act. If you have any questions about FIPPA,
please contact the Access and Privacy Consultant at [email protected] or 705.728.1968 ext. 5770.
Host Family Application Form
HOST
FAMILY APPLICATION
Host Family Application Form