Homestay Application Form « Southern Ontario Collegiate

Family Information

Applicant's Full Name *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country *

Phone *

Email Address *

Number of people living in the household *

Household members including yourself

Name *

Age *

Relationship to you *

Number of bedrooms available for students *

Number of bathrooms *

Will you provide meals for the students? *YesNo

If yes, what type of meals will you provide?

Can you accommodate special dietary needs (e.g., vegetarian, gluten-free)? *YesNo

How will you provide support and supervision for the students? *

What rules and expectations will you have for the students? *

How will you communicate with the students and the school? *

Have you or any household member undergone a Vulnerable Sector Screening (VSS) within the last 5 years? *YesNo

If yes, please provide the date of the screening

If yes, please provide the organization that conducted it

If no, are you willing to undergo a VSS as a condition of hosting students? *YesNo

Name *

Phone *

Email Address *

Name *

Phone *

Email Address *

Signature *

Date *