First Name:

Last Name:

Sex: male female

Date of Birth: Month: JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember  Day:  Year:

You must be at least 18 years old to begin classes at ALPS.

Your E-mail address:

Name of friend in Washington state:

Full Telephone # of friend:

Part 2 of 3: Family Information

Father's full Name:

Mother's full Name:

Father's/Mother's Address: Full Address Include Country

Full telephone number of mother & father:

Profession of Mother:

Profession of Father:

Part 3 of 3: Questionnaire

Is this your first trip abroad? (Please explain)

Have you participated in a homestay before? Yes No

Would you mind living in a household with another student from your country? Yes No

Have you studied English: Yes No

How long do you plan to study in Seattle?

Approximate Date of Arrival:

Note: Airport service is not available on holidays or between the hours of 8:00 p.m.-6:00 a.m.

Holidays: 2012: December 24, 25, 26, 31. 2013: January 1, 19, 20, 21; February 16, 17, 18; April 16; May 12, 25, 26, 27, 28; June 16; July 4; September 1, 2; October 12, 13, 14; November 9, 10, 11, 28; December 24, 25, 26, 31. 2014: January 1, 18, 19, 20; February 15, 16, 17; April 20, May 11, 24, 25, 26; June 15; July 4, 5, 6; September 1; October 11, 12, 13; November 11, 27; December 24, 25, 26, 31

*All weekend and evening arrivals will incur a $100 fee in addition to the placement fee.

Do you plan to drive a car while in America? Yes No

What company will you have your car insurance with?
(car insurance is mandatory in Washington State.)

Medical insurance is required for all students using an F-1 student visa.

Do you have medical insurance?: Yes No, I will use the insurance provided by ALPS.

If yes, what is the name of your insurance company?

Would you like young children in your homestay? Yes No

(This question is asked solely to determine your opinion. It in no way implies that you will be expected to babysit.)

Do you like pets? Yes No

(It may not be possible to place you in a pet free home because most Americans have pets.)

Do you smoke? Yes No

(Most Americans do not allow smoking in their homes, so you may be asked to smoke outside only.)

Do you drink alcohol?: Yes No

Would you feel comfortable with a host that drinks occasionally? Yes No

(A program of study or work can be both physically and emotionally stressful. Should an emergency arise while you are overseas, it is important that Intercultural Homestays and Services, be aware of any past or potential medical conditions that you may have. A frank evaluation of your health is essential to your safety)

Do you have any physical or mental disabilities (e.g. allergies to food or pets, special dietary needs, physical restrictions, etc.)

Are there any foods you do not eat? (If yes explain)

Do you have any religious restrictions?(If yes explain)

Explain what you expect of your homestay:

What would you like your new host to know about you?

Which of the following best describes you, in terms of being placed in a foreign household?

Independent of home and family life Adventurous
Quiet and Reflective Outgoing and Sociable

What are your hobbies?

What are your favorite sports?

Instructions: Please answer all questions and press the Submit Application button below.

We cannot guarantee that all of your housing preferences will be met, but our housing coordinator will use the information to help arrange a compatible placement. Please read the waiver and release agreement documents to be fully aware of our policies and liabilities