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BECOME A HOST FAMILY
  Language Achievement Canada (LAC) is always looking for good host families who are willing to invite international students and visitors to become a member of their family.
   

HOST FAMILY APPLICATION FORM

Please complete and submit this form if you would like to join our Host Family Program. Please enter information in EACH form field. Missing or incorrect information may result in the inability to process your form.

 
Name and Address
Host Mother Name:
Host Father Name:
Address:
City:
Province:
Postal Code:
Intersection:
Home Phone:
Work Phone:
Email Address:
 
Family Information
Mother's Occupation:
Employer:
Father's Occupation:
Employer:

Please list all persons living in your home, excluding yourself:
Occupant Name:
Relationship:
Age:
Gender:
Hobbies/Interests:
 
Occupant Name:
Relationship:
Age:
Gender:
Hobbies/Interests:
 
Occupant Name:
Relationship:
Age:
Gender:
Hobbies/Interests:
 
Occupant Name:
Relationship:
Age:
Gender:
Hobbies/Interests:
 
Occupant Name:
Relationship:
Age:
Gender:
Hobbies/Interests:

Please provide 2 References that are not related to your family:
Reference Name:
Relationship:
Address:
Telephone #:
 
Reference Name:
Relationship:
Address:
Telephone #:

Primary language spoken in the home:
Other:

We have pets in our home:
No
Yes (Please describe below)

Some occupant(s) in our home:
Smoke Tobacco
Have Allergies
Are Vegetarians
Other (please describe below)

Some occupant(s) have been convicted of a crime:
No
Yes

Total minutes to Downtown via OC Transpo (non-Express):
Bus # (To Downtown)

Our family has hosted before:
No
Yes
If Yes, name of organization:

Total number of beds available in the home:

Location of our student bedroom:
Upper Level
Main Level
Basement
Other (please describe below)

The student will have to share a bedroom:
No
Yes (Please describe below)

Students will have access to the following:
PC
Internet
Kitchen (Snacks/Meal Prep)
Private Washroom
 
Host Family Terms And Conditions
I/We hereby state that all information provided in this application form is truthful and correct, and I/We permit LAC - Language Achievement Canada to contact my references and obtain a police background check for all family members 18 years of age and over, upon request (at host family's expense).
 
Host Family E-Signature:
Date:

 

your home away from home

2006 Language Achievement Canada. All rights reserved.   Rev. 03.14.07