English Language Program Application

Student Information
Student's name *
Student's name
Program: *
Student's date of birth *
Student's date of birth
Student's gender *
English language level: *
Contact Information
Mother's name (if child is under 18)
Mother's name (if child is under 18)
Father's name (if child is under 18)
Father's name (if child is under 18)
U.S. Contact Information (if applicable)
Phone (U.S.)
Phone (U.S.)
Family Background
Do you wish to apply for a homestay with an American host family? *
Do you smoke? *
How do you feel about pets? *
Introduce yourself to your new American host family. Describe your background, home country, hobbies and interests, area of study, and future plans. What do you want to share with your family? What do you hope to learn about them?
All applicants for homestay and hospitality programs under the auspices of the International Hospitality Center are responsible for providing their own personal spending money and incidental expenses. Participants must have valid health, accident, and liability insurance, valid passport, and visa. The International Hospitality Center will not be responsible for any debts or medical expenses incurred during your homestay program. You agree to accept full responsibility for any and all medical and personal expenses incurred, and give permission for such emergency treatment as might be necessary. I, the undersigned, hereby fully accept the responsibilities described above. *