405, Sherbrooke East, # 201
Montréal (Québec)
H2L 1J9
Metro Sherbrooke
+1 (514) 841-9195
learn@languageexchangecenter.com
Homestay
Homestay Request Form
Homestay Request Form
Personal Information
Gender:
------
male
female
First Name:
Last Name:
Address:
City:
Province:
Country:
Postal Code:
Home Tel:
Fax:
E-Mail:
Birth date (day/ month/ year):
Briefly describe your studies:
What is your profession?
What are your interests?
Do you smoke?
---
yes
no
Nationality:
How many years have you studied?
English:
French:
Person to contact in case of emergency:
Relationship:
Home tel:
Work tel:
Homestay preferences and details
Arrival:
Departure:
What type of family would you like to stay with?
Francophone
Anglophone
Bilingual
Either
Smokers
Non-smokers
Family
Family With children :
please select
not important
important
very important
Family Without children :
please select
not important
important
very important
Either :
please select
not important
important
very important
Would you accept other foreign students in the homestay?
---
yes
no
1) Have meals with the family
---
yes
no
2) Access to the kitchen
---
yes
no
3) Other
---
yes
no
Arrival
Airport pick-up ?
---
yes
no
If yes, please indicate flight details:
Please add $100 airport pick-up fee to the homestay deposit
Num. of meals:
please select
Homestay Plan I
Homestay Plan II
Bed & Breakfast Homestay Plan
Payment: Please refer to the payment section on the registration form
To return the homestay registration form:
Fill out the registration form and send it by mail, indicating your mode of payment : credit card or direct deposit
Our address:
405, Sherbrooke East, # 201, MONTREAL (QC)Canada H2L 1J9
Telephone:
+1 (514) 841-9195
Email:
learn@languageexchangecenter.com
