
Host Student Application
寄宿家庭申请表
First Name(姓)*
Last Name(名)*
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)*
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)*
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)*
Part 1
Part 2
Part 3
Part 4
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