Homestay Service Request Form

Please fill-out this homestay request form and we will process your request. Please fill in the form in ENGLISH. Thank you.

 

Campus:

Campus: :
RosemeadTorrance

 

Student Information:

Family Name :
First Name : *
Middle Name (If any) :
Telephone :
Your Email :
Date of Birth :
Age :
Gender :
MaleFemale
Country of Birth :

 

Emergency Contact Information - A contact person who is living in Los Angeles ( Optional )

Person's Name :
Telephone :
E-mail :
Address in Los Angeles :

 

Arrival Information : ( If known )

Airline :
Flight Number :
Date :
Time :

 

Questions:

Do you smoke ? :
YesNo
If "yes", can you smoke outdoors only ? :
YesNo
Do you drink alcohol ? :
YesNo
Is family with children OK? :
YesNo
Is family with pets OK? :
YesNo
Do you want to include 2 meals? :
YesNo
Who do you want your food prepared by? :
Your Host FamilyYourself
What form of transportation will you use? :
Car
Bus
Other
Other
How long will you stay in Los Angeles? :
Which date will be your first day of homestay ? :
Which date will be your final day of homestay ? ( If known ) :
Other necessary information
( please let us know if you have any special needs or requests ) :
:

 

Please fill-out this homestay request form and we will process your request. Please fill in the form in ENGLISH. Thank you.

 

Campus:

Campus: :
RosemeadTorrance

 

Student Information:

Family Name :
First Name : *
Middle Name (If any) :
Telephone :
Your Email :
Date of Birth :
Age :
Gender :
MaleFemale
Country of Birth :

 

Emergency Contact Information - A contact person who is living in Los Angeles ( Optional )

Person's Name :
Telephone :
E-mail :
Address in Los Angeles :

 

Arrival Information : ( If known )

Airline :
Flight Number :
Date :
Time :

 

Questions:

Do you smoke ? :
YesNo
If "yes", can you smoke outdoors only ? :
YesNo
Do you drink alcohol ? :
YesNo
Is family with children OK? :
YesNo
Is family with pets OK? :
YesNo
Do you want to include 2 meals? :
YesNo
Who do you want your food prepared by? :
Your Host FamilyYourself
What form of transportation will you use? :
Car
Bus
Other
Other
How long will you stay in Los Angeles? :
Which date will be your first day of homestay ? :
Which date will be your final day of homestay ? ( If known ) :
Other necessary information
( please let us know if you have any special needs or requests ) :
:

 

Please fill-out this homestay request form and we will process your request. Please fill in the form in ENGLISH. Thank you.

 

Campus:

Campus: :
RosemeadTorrance

 

Student Information:

Family Name :
First Name : *
Middle Name (If any) :
Telephone :
Your Email :
Date of Birth :
Age :
Gender :
MaleFemale
Country of Birth :

 

Emergency Contact Information - A contact person who is living in Los Angeles ( Optional )

Person's Name :
Telephone :
E-mail :
Address in Los Angeles :

 

Arrival Information : ( If known )

Airline :
Flight Number :
Date :
Time :

 

Questions:

Do you smoke ? :
YesNo
If "yes", can you smoke outdoors only ? :
YesNo
Do you drink alcohol ? :
YesNo
Is family with children OK? :
YesNo
Is family with pets OK? :
YesNo
Do you want to include 2 meals? :
YesNo
Who do you want your food prepared by? :
Your Host FamilyYourself
What form of transportation will you use? :
Car
Bus
Other
Other
How long will you stay in Los Angeles? :
Which date will be your first day of homestay ? :
Which date will be your final day of homestay ? ( If known ) :
Other necessary information
( please let us know if you have any special needs or requests ) :
:

 

Please fill-out this homestay request form and we will process your request. Please fill in the form in ENGLISH. Thank you.

 

Campus:

Campus: :
RosemeadTorrance

 

Student Information:

Family Name :
First Name : *
Middle Name (If any) :
Telephone :
Your Email :
Date of Birth :
Age :
Gender :
MaleFemale
Country of Birth :

 

Emergency Contact Information - A contact person who is living in Los Angeles ( Optional )

Person's Name :
Telephone :
E-mail :
Address in Los Angeles :

 

Arrival Information : ( If known )

Airline :
Flight Number :
Date :
Time :

 

Questions:

Do you smoke ? :
YesNo
If "yes", can you smoke outdoors only ? :
YesNo
Do you drink alcohol ? :
YesNo
Is family with children OK? :
YesNo
Is family with pets OK? :
YesNo
Do you want to include 2 meals? :
YesNo
Who do you want your food prepared by? :
Your Host FamilyYourself
What form of transportation will you use? :
Car
Bus
Other
Other
How long will you stay in Los Angeles? :
Which date will be your first day of homestay ? :
Which date will be your final day of homestay ? ( If known ) :
Other necessary information
( please let us know if you have any special needs or requests ) :
: