Host Student Application

​寄宿家庭申请表

First Name()*

Last Name()*

Nickname(英文名

1. Student Information/学生信息*.

2. Parents/Guardian Information/父母/监护人信息*.

Email(电子邮箱)*

Mobile Phone(手机号)*

DOB(出生日期)*

Nationality(国籍)*

Language Spoken(语言)*

Gender(性别)*

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Father(父亲)*

Full Name(全名)*

Age(年龄)*

Occupation(职业)*

Email(电子邮箱)*

Home Phone(家庭电话)*

Mobile #(手机号)*

Mother(母)*

Full Name(全名)*

Age(年龄)*

Occupation(职业)*

Email(电子邮箱)*

Home Phone(家庭电话)*

Mobile #(手机号)*

US Guardian(在美监护人)*

Full Name(全名)*

Email(电子邮箱)*

Mobile #(手机号)*

Address(在美地址)*

Work #(工作电话)*

Relationship(关系)*

Relatives/Friends in the U.S.(在美亲戚/朋友)*

Full Name(全名)*

Email(电子邮箱)*

Mobile #(手机号)*

Full Name(全名)*

Email(电子邮箱)*

Mobile #(手机号)*

3. Homestay Information/寄宿信息*.

Expected Homestay Length(预计在美居住时间)*

Starting Date:

(开始日期)*

Ending Date:

(结束日期)*

Requested Homestay Type, Please choose one*(寄宿家庭居住类型,请选择一个)*

Private room with meal (breakfast & dinner) (私人卧房,包吃住)

Shared room with meal (breakfast & dinner) (共享的卧房,包吃住)

*Two students must move-in on the same day to get the shared room rate.

(两个学生同时入住才能享受到共享卧室的收费标准)*

Flight Info & Passport Number(请提供航班信息以及护照号)*

Arrival Date

到达日期)*

Airline

航空公司)*

Flight #

航班号)*

Departure Airport

出发机场)*

Arrival Airport

到达机场)*

Departure Time

出发时间)*

Passport #

护照号)*

Arrival Time

到达时间)*

4. Self-Introduction/自我介绍*.

Check any of the following that most describe you(打钩选择以下适合您的形容词,可以多选*)

Outgoing (外向的)

Quiet (安静的)

Shy (内向的)

Serious(严肃的)

Comical (有趣的)

Artistic(爱艺术的)

Talkative (话多的)

Athletic(爱运动的)

What are you interests and hobbies?(您有哪些兴趣爱好?*)

Any allergies, medical conditions?(您有需要注意的过敏或医疗需求吗?*)

Do you take prescribed medicine on a daily basis? (您是否在接受药物治疗?*)

Do you have a pet allergy? What kind?(您有对动物过敏吗?*)

Do you have U.S. health/accidental insurance? (您有美国保险吗?*)

Who will be financially responsible for your homestay fee? (谁负责您的寄宿家庭费用?*)

How did you hear about U.S. Homestay 360? (您是从哪里知道US Homestay 360机构的?*)

Any Questions? (如果有任何问题或特殊要求,请在下面说明?*)

I confirm that all questions are accurate and completed.

Application entered by:

(填写人名字)*

Home Address

现居住地址)*

Home Phone #

家庭电话)*

U.S. School Name:

(在美就读学校)*

U.S. School Grade:

(就读年级)*

 
 
 
 
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