Home Placement Services, homestay for foreign and domestic students Application.

Home Placement, Foreign and Domestic Students

HOMESTAY APPLICATION

Home Placement Services, Inc.
P.O. Box 181002
Coronado, CA 92178-1002

Phone 619-423-1449; Fax 619-423-1480
Calls Outside of San Diego County
866-731-7204 (Toll free)
E-mail: hpservices@san.rr.com

Homestay applications should be sent to our office at least 30 days before your scheduled arrival date so that there is sufficient time to assign a host family that meets the criteria as outlined in your application. After we receive your application, we will contact you regarding Placement Fees, our Airport Greeting and Pickup service and any other fees that may relate to your application. Thank you for choosing Home Placement Services Inc., the premier homestay service for all of Southern California.

HomeStay host Provides:

A private bedroom, bed, linens, desk, study lamp, closet for clothing, personal storage space.

Two meals, breakfast and dinner, every day of your stay.

Laundry privileges.

If you do not have a car, the location of the best possible bus schedule to school and return.

Help to increase your language skills and knowledge of our culture through conversation, shopping trips, family activities and outings (should you wish to participate).

PLEASE COMPLETE THE FOLLOWING FORM AND CLICK SUBMIT
If desired, click here for a printable application form in pdf format. Print form, fill out
and forward the completed form with your payment to the address listed below.

Homestays are not assigned until all fees have ben received.

Personal Information: Please complete all fields. This information will be used to facilitate your placement and better prepare your homestay family for your arrival.

Last Name: * First Name: *

Age: * Date of Birth: * Gender: * Male Female

Marital Status: * Single Married Divorced

If married, please include the name of spouse: *

Address: * City: * State/Province: *

Country: * E-mail: *

Telephone: * Cell Phone: * Fax: *
(Where applicable please include Country Code - Area Code - Number)

Nationality: * Native Language: * Other Languages Spoken: *

HomeStay start date: * HomeStay ending date *
Month / day / year Month / day / year

Do you plan to have a car during your stay: * Yes No

Please rate English conversation Ability: * Low Intermediate Advanced

Do you Smoke? * Yes No

Would you be comfortable in a home that permits smoking? * Yes No

Would you be comfortable in a home that permits alcohol? * Yes No

Would you be comfortable in a home with young children (under 6 years)?*
Yes No

Would you be comfortable in a home with pets? * Yes No

Dog: * Yes No Cat: * Yes No

Please list allergies or health problems your host will need to know about. Please list any foods you cannot eat, due to allergies, health problems, or personal beliefs:

If you practice religions, what is your faith?

Please list your current Hobbies: *

Which School do you plan to attend? *

School/Campus Address *

School/Campus City *

What schools have you attended in your past course of studies?
(Include other language schools and their locations)

List any degrees, certificates, or diplomas you have obtained and the year you graduated:

Degree, Diploma or Certficate	Year Graduated:

Describe what you are currently doing in your Country?
(for example: University student, working for a company, etc.)

What are your career interests and future plans of study?

Please tell us about your family.
(How many family members, their ages, and occupations)

Is there any else you would to say about yourself and your homestay expectations?

Emergency Contact in your native Country:

Emergency Contact: * Relationship: * Telephone: *

Address: * City: * State/Province: *

Country: * E-mail: *

Emergency Contact in the U.S.A.:

Emergency Contact: * Relationship: * Telephone: *

Address: * City: * State/Province: *

E-mail: *

Flight information: (If applicable)

Airline: Flight Number:

Arrival Date: Arrival Time:
Month / day / year

We offer airport greeting service from San Diego airport:
Within the immediate San Diego City area - $75.00. North San Diego area: $125.00.

In most cases students are met at the gate, or near the baggage claim. You receive a warm greeting by a Home Placement Services, Inc. employee at the airport, assistance with your baggage, transportation by private car to your HomeSsay, and an introduction to your Host Family.

Please indicate if you wish an Airport Greeting. Yes No

By electing to SUBMIT this application by electronic means,
you are hereby certifying that you have read, understood,
and agreed to the non-refundable application fee.

Home Placement Services, Inc.
P.O. Box 181002
Coronado, CA 92178-1002

Home Placement Services, Inc. · Coronado, California
Tel. (619) 423-1449 · (866) 731-7204 (Outside San Diego) · Fax (619) 423-1480

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