Medicine Hat College ID#

Last ( Family) Name:

First (Given) Name:

English/Preferred Name:

Date of Birth (dd/mm/yyyy):

Gender:

Female

Male

Other

Email Address:

Full Mailing Address:

Nationality:

What languages do you speak?

Level of English (pick one):

Beginner

Intermediate

Advanced

Program of Study:

Guardian (1) Last Name, First Name:

Guardian (2) Last Name, First Name:

Email Address (1):

Email Address (2):

Telephone/Cell Phone (1):

Telephone/Cell Phone (2):

Permanent Address in Home Country:

Last Name, First Name:

Relationship:

Email Address:

Telephone/Cell Phone:

Name of Agent (Last Name, First Name):

Email Address:

Telephone/Cell Phone:

Do you want your agent to receive your Homestay information?

Yes

Which semester are you applying for?

How long do you plan to stay in Homestay?

What date will you arrive in Canada? (if known)

Flight Number (if known):

Flight Time (if known):

Have you travelled and stayed outside of your country before?

Yes

If yes, please specify:

Have you lived in a Homestay before?

Yes

How do you feel about living in Canada?

What you looking forward to about living in Canada?

What are you worried about when you come to live in Canada?

What hobbies and activities do you enjoy?

How would you describe yourself? (check all that apply)

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Homestay Application for International Students

Challenges May Arise

Application Fee

Questions?

Application Form

FOIP

The Student agrees to: