Main Applicant |
Your First Name * |
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Your Family Name * |
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Date of Birth * |
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Street and Street Number * |
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City * |
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Postal Code * |
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Country * |
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Contact Details |
Home Phone * |
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Work Phone * |
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Cell Number |
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Email Address * |
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Website |
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Skype Address |
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Specify the number of household members living at your address * |
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Please list all household members living at your address * |
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Location Details |
Are you within walking distance of ECLC? * |
Yes No |
How many kilometres are you from the school? * |
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What is the closest intersection to your house? * |
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Are you on a bus route? * |
Yes No |
If yes, what route number? |
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How many minutes to downtown Halifax by bus? * |
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Accomodation Details |
Please provide a description of your home * |
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Please provide a description of the area that you live in * |
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Please provide a description of the Student bedroom * |
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Which of the following are available for students to use in your home? |
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Do you have internet access? * |
Yes No |
Do you have High Speed Internet? * |
Yes No |
Is there a wireless network? * |
Yes No |
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Lifestyle Information |
Are there pets that live in your home? * |
Yes No |
If Yes, please specify |
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Smoking outside is allowed * |
Yes No |
Are there any other restrictions? * |
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Main language used in the household * |
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Student gender preference * |
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List any other preferences * |
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You will provide assistance with * |
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Our typical weekend activities include * |
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Hobbies of Family Members * |
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Any other details you feel are relevant |
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Introduction letter to your student * |
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Security |
All successful applicants
will be required to sign our Homestay contract and provide a police
certificate for each resident in the home that is 18 years of age or
older. |
By submitting this application, you declare that all information is true and accurate to the best of your knowledge. * |
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Anti-Spam Validation: |
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