Homestay Application

Homestay Application

Are you requesting Airport Transport and Assistance?  Yes No

Are you requesting to live with an American family in our Homestay program?  Yes No

If YES, please complete the homestay section below.

Family Name (one only please)

First Name

Your Email (required)

Address in your country

City

State

Country

Zip Code

Home Phone Number

Work / Mobile Phone

Address in the US

City

State

Zip Code

Home Phone

Work / Mobile Phone

Date of Birth

mm/dd/yyyy

City of Birth

Gender

Country of Birth

City of Birth

Country of Citizenship

Native Language

Profession

Emergency Contact Name

Emergency Contact Phone Number

Estimated date of Homestay Arrival and Departure

From

mm-dd-yyyy

To

mm-dd-yyyy

Airport arrival information

Date

mm-dd-yyy

Airline

Flight Number

Airport

Health problems (Asthma, Allergies, etc.)

Foods you can't eat

Hobbies

Conditions

Requests for Homestay must be made at least four weeks in advance. After you pay the one-time non-refundable Finder's fee, inlingua® will look for a family. The minimum stay is one month, unless you notify inlingua® of a shorter initial period when requesting this service. Click here to read the Homestay Conditions.

 I acknowledge that I have read the Homestay conditions.

Applicant Name

Date

Payment Information

Method of Payment

Other

For Check, Money Order or Other: Your application can only be processed after receiving your payment

Credit Card Number

Name as it appers on Card

Card Expiration Date

Share|