Homestay Placement Application |
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 Company or Branch Name |
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| Agent personal name |
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| Agent Phone Number |
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| Agent E-mail to Reply |
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| Student Email |
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| Student Korean Name |
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| Student English Name |
Last Name:
First Name:
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 Gender/Age |
Male
Female
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| Date of Birth |
/
/
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| Student Home Phone |
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| School Name |
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| Visa Type |
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| Class start Date |
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| Staying Months in Canada |
months
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| ACS |
Yes
No
(ACS: After Care Service)
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Homestay information |
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| Smoking |
Yes
No
N/A
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| Pet |
Yes
No
N/A
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| Children |
Yes
No
N/A
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| Allergies |
If yes, What is it?
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Airport Pickup Information
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| Airport Pickup |
Yes
(If you need pickup only, click here
) |
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| Arrival Date |
Time
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| Flight No |
Airline
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Special Comment |
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| Comment |
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