Family Application Form To be filled out by a host family parent. Contact Information for main hostName* First Last Home Phone #*Work Phone #Work Phone Extension #Cell Phone #Fax #Email* Address*Please enter your Quebec address. Street Address Address Line 2 City Postal Code Type of Residence*HouseDuplexAppartmentCondoOccupation*Describe your typical work week/hours. Contact Information for Vanier StudentIf applicableName First Last Student IDPhoneEmail Family MembersList individuals in your home/family. Include members that live independently, but visit often.Family Members*Full NameOccupationGenderRelationshipBirth CountryBirth Date Family Illnesses or disabilities*Do any family members suffer from a serious illness or a physical/mental disability that may possibly affect the visiting student? Yes No Describe the illness or disability* Languages spoken at home* English French Spanish Italian Chinese Arabic Other Other languagesEnglish/French speaking environment*To what extent will you be able to provide an English or French speaking environment for your visiting student? Do you have any pets?*YesNoDescription of pets* Accomodation InformationPlease check off the specifics of the accommodations/facilities you are able to provide:House accomodations* Private room Shared room (2 international students) Single bed Double bed Quiet workspace Lamp Drawers/closet Bedding/sheets/towels Access to laundry Computer Internet/Wifi 2 Meals 3 Meals Number of available rooms*Do you have a car?*YesNoAre you able to do airport pick up/drop off?*YesNoDo you or does anybody in your family drive to Vanier?*YesNoForms of transit available*Which forms of transit are within walking distance of your home? Bus Metro Train Metro Station near you*Length of commute to Vanier (in minutes)*Length of commute that the visiting student could expect in getting from your home to Vanier College.In an emergency, would you be able to accommodate another visiting student?*YesNoWould you agree to a criminal background check?*YesNoHave you hosted international students before?*YesNoDescribe your experience*Tell us about your past experiences with hosting international students. Family DetailsDoes your family prefer:*MaleFemaleNo preferenceFamily Member Descriptions*Describe each member in the family (including yourself) as to personality, interests, etc. Typical Weekdays and Weekends*Describe a typical weekday and weekend in your family. Activities and Hobbies*What activities and or hobbies do you or any of your family members enjoy? Please also mention any common activities and interests. Do you include the student in your family outings?*YesNoChoresWhat kind of chores do you expect family members to help with around the house? Family Values*Describe what is important to your family. What are your family values? Rules at home*What kinds of rules do you have in your household? (Such as curfews, limits on computer, TV or telephone use, etc.) Does anyone smoke in your home?*YesNoWhat rules apply to smoking in your home?* Does your household have any dietary restrictions?*YesNoDescribe the dietary restrictions* Would you be willing to host a vegetarian or someone with dietary restrictions?*YesNoPrefer NotAdditional Comments AgreementThe information I have provided in this form is truthful and accurate. In addition, I have read and understood the responsibilities and conditions of the Host Family Guide, and I agree to fulfill my obligations. Please be assured that information provided in this application form will remain confidential and will be used only for this homestay program.