Canadian Conversation College

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Thank you for your interest in becoming a host family with Canadian Conversation College. If you would like to become a host family for our international students, please complete the form below. Before you send this form after completion, please read our Terms & Conditions carefully. You can also print this application form, fill out and fax or mail it to us.

Fax Number: 263-2039
Address: Canadian Conversation College
#300, 100-4th Avenue S.W. Calgary AB T2P 3N2

General Information

First Name
Last Name
Title	Mr. Ms.
Date of Birth	/ / ( mm / dd / yy )
Occupation
Company
Home Address
Telephone Numbers	Home:
	Work:
	Cell:
Fax Numbers
E-mail Address

Please list the members of your family and other people living at home.

Name	Age	Relationship	Occupation
Name	Age	Relationship	Occupation
Name	Age	Relationship	Occupation
Name	Age	Relationship	Occupation
Name	Age	Relationship	Occupation

Do you speak English as a mother language?	Yes No
If no, What is your mother language?
What are main activities or hobbies of your family?
Do your family have pets?	Yes No
If Yes, What kind of pets?
How many do you have?
Have you or any other family ever been arrested or convicted for any criminal offence?	Yes No
Are there any special health conditions in your family?	Yes No

Homestay Information

How many bedrooms are available for homestay?
Is the internet connection possible in the rooms?	Yes No
Do you prefer male students or female students?	Male Female No Preference
Would you permit outside smoking?	Yes No
Is your home located within walking distance to a bus stop or a LRT station?	Yes No
Would you be willing to provide airport pick up service for the student?	Yes No
Have you ever hosted international student before?	Yes No
Are there any comments you would like to leave to the future guests?

Terms and conditions
1. The monthly Homestay fee is $600.00 or if necessary $20.00/ day. The fee should be paid directly to the family from the students.
2. The host families should provide the students with
   - a clean furnished bedroom and a bathroom facility
   - necessities such as toothpaste, shampoo, and detergent
   - a breakfast, lunch & dinner
3. The home should be safe and comfortable, and has hospitable environment.
4. The families should be friendly and helpful so that the international students are given plenty of opportunity to practice their English.
5. The host families should be willing to include the students in family activities.
6. The hosts are strongly encouraged to provide airport pickup for the students as a mark of welcoming them.
7. Canadian Conversation College recommends that the hosts provide the written house rules to ensure a mutual understanding.
8. The hosts should understand that Canadian Conversation College is not liable for any damages or loss caused by the hosts or the students.

By signing below, I certify that the information provided above is accurate, and I have read and understand the terms and conditions of Host Family.

Full Name:		Date:	/ /
Signature:

* Canadian Conversation College will be contacting you by phone or email when we have students available for you.

#300, 100-4th Avenue S.W. Calgary AB Canada T2P 3N2

Tel: 1-403-263-2034 Fax: 263-2039 E-mail: ccccalgary1997@gmail.com