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 & Placement Fees should be sent to our office at least 45 days before student arrival date. The (one-time, non-refundable) placement fee of $250.00 needs to be paid before a HomeStay can be assigned. The monthly HomeStay charge of $665 is due on or before the date that you move into your HomeStay. Without fees, the application is considered incomplete, and placement will not be assigned. HomeStay fees received less than 30 days before HomeStay start date require an additional $25.00. Rushed placement fee total is $275 (one time non-refundable). All payments to Home Placement Services, Inc. coming from within the U.S. may be made by credit card, a cashier's check, or money order. Payments coming from outside the U.S. may be made by credit card (faster and less costly), or bank wire. Placement fees & other charges, made by credit cards or personal checks, need to be made through contacting our office. Please include a picture with your application and fees.

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. Print form, fill out and forward
the completed form with your payment to the address listed below.

APPLICATIONS WILL NOT BE CONSIDERED UNTIL PLACEMENT FEES are RECEIVED.

Personal Information: Please complete all fields possible. Those noted by (*) are required.

Last Name: * First Name: *

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

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

Which School do you plan to attend? *

School/Campus Address *

School/Campus City *

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 with children? * Yes No

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

Dog: * Yes No Cat: * Yes No Other Specify: *

Hobbies: * Career Interest: *

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:

Emergency Contact: * Relationship: * Telephone: *

Address: * City: * State/Province: *

Country: * E-mail: *

Flight information: (If applicable)

Airline: Flight Number:

Arrival Date: Arrival Time:
Month / day / year

We offer airport pick up service from San Diego airport:
Within the San Diego area - $50.00.

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

Please indicate if you wish an airport pick up. Yes No

By electing to SUBMIT this application by electronic means, you are hereby
certifying that 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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