Fillable-Homestay-Application

97 Kaulbach St, Lunenburg, NS B0J 2C0 | PO Box 987 info@studyatlantic.com studyatlantic.com 1-902-634-6111
Homestay Family Application Form
- • If no electronic signature is available, our Accommodation Coordinator will have the applicant sign the application form upon initial meeting. • Please e-mail your completed form to admissions@studyatlantic.com
First Name*
Initial
Last Name*
Address*

Street Address

Street Address Line 2

TownState / Province

Postal / Zip Code
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth (dd/mm/yyyy)*

MonthDayYear
Date
Main Phone*
Please enter a valid phone number.
Secondary Phone
Please enter a valid phone number.
Email*
example@example.com
97 Kaulbach St, Lunenburg, NS B0J 2C0 | PO Box 987 info@studyatlantic.com studyatlantic.com 1-902-634-6111

Type a question*

	Name	Birthday (dd/mm/yy)	Occupation
Member 1
Member 2
Member 3
Member 4
Member 5
Member 6

KMs from school*
How will students travel to school each day?*
How many kilometers is your home from the school?

How will students travel to school each day?
97 Kaulbach St, Lunenburg, NS B0J 2C0 | PO Box 987 info@studyatlantic.com studyatlantic.com 1-902-634-6111
Description of Home
Description of Neighbourhood
Description of Student’s Bedroom
Which of the following are available to the student in your home?
Options in this home*

Private BedroomShared BedroomPrivate BathroomShared BathroomCloset/DresserCable/Satellite TVWIFIQuiet Study space with one deskHome-cooked MealsOther
97 Kaulbach St, Lunenburg, NS B0J 2C0 | PO Box 987 info@studyatlantic.com studyatlantic.com 1-902-634-6111
Do you have any pets?*

YesNo
If yes, please specify
Do any family member smoke?*

YesNo
Will the student be permitted to smoke?*

YesNo
What are your family’s hobbies?
Does your family follow a special diet? ie. vegetarian, vegan, no pork diet, etc.
97 Kaulbach St, Lunenburg, NS B0J 2C0 | PO Box 987 info@studyatlantic.com studyatlantic.com 1-902-634-6111
What is the main language used in the household?*
Do you have a student gender preference?

FemaleMale
What is your student age preference, if applicable?

Are there laundry facilities available to the student?
What is your student age preference (if applicable)?
Are there any laundry facilities available to the student?*

YesNo
Are you able to drive the student to/from (some) local events/activities?

YesNo
Are there any specific household restrictions?
Please list any other restrictions/preferences.
97 Kaulbach St, Lunenburg, NS B0J 2C0 | PO Box 987 info@studyatlantic.com studyatlantic.com 1-902-634-6111
SECURITY
All successful application will be required to sign our homestay contract for each student that they host. They will also be required to consent to periodical home inspections and must provide a police record check for each resident in the home that is 18 years of age or older. Child Abuse Checks must also be completed for families hosting minor students.
By submitting this application, you declare that all information is true and accurate to the best of your knowledge.*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty:

SECURITY