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 CommentsAgreementThe 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.