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Host Family Application

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Host Profile – Primary Contact – Step 1 of 6

Data Collection, Use and Consent

This application form collects private information about you so that we can determine the type of homestay environment you offer and the features of your family and home that may be of interest to prospective students. Please review our Privacy Policy for details on how we protect and manage the information you provide. Your consent is required to proceed.

Acknowledgement *

I consent to the collection and use of my data

Primary Contact

When completing this section, please identify one individual from the host family who will serve as the primary contact between your home and our company.

First Name *

Last Name *

Gender *

Occupation *

Street Address *

City *

Province *

Postal Code *

Primary Phone *

Secondary Phone (optional)

Email Address *

Email

Confirm Email

Adults in the Home

Enter the total number of adults (over 18 years of age who regularly reside within the home) and, where requested, provide information about them.

Total number of adults residing in the home (including yourself) *

1
2
3
4
5
6

Adult #2: First Name *

Adult #2: Last Name *

Adult #2 Gender *

Adult #2: Occupation *

Adult #2: Relationship to Primary Contact *

Adult #3: First Name *

Adult #3: Last Name *

Adult #3 Gender *

Adult #3: Occupation *

Adult #3: Relationship to Primary Contact *

Adult #4: First Name *

Adult #4: Last Name *

Adult #4 Gender *

Adult #4: Occupation *

Adult #4: Relationship to Primary Contact *

Adult #5: First Name *

Adult #5: Last Name *

Adult #5 Gender *

Adult #5: Occupation *

Adult #5: Relationship to Primary Contact *

Adult #6: First Name *

Adult #6: Last Name *

Adult #6 Gender *

Adult #6: Occupation *

Adult #6: Relationship to Primary Contact *

Minor-aged Persons in the Home

Please enter the total number of children/teens (under 19 years of age) who regularly reside within the home and provide the given name, year or birth, and gender for each child/teen listed.

Total number of minor-aged children/teens residing in the home. *

0
1
2
3
4
5
6

Minor #1: First Name *

Minor #1: Gender *

Minor #1: Year of Birth *

Minor #2: First Name *

Minor #2: Gender *

Minor #2: Year of Birth *

Minor #3: First Name *

Minor #3: Gender *

Minor #3: Year of Birth *

Minor #4: First Name *

Minor #4: Gender *

Minor #4: Year of Birth *

Minor #5: First Name *

Minor #5: Gender *

Minor #5: Year of Birth *

Minor #6: First Name *

Minor #6: Gender *

Minor #6: Year of Birth *

Pets in the Home

Please enter the total number of pets that reside at your home and indicate the name, type, and characteristics of each pet listed.

Total number of pets residing in the home.

0
1
2
3
4
5
6

Pet #1: Given Name *

Pet #1: Type of Pet *

Pet #1: Characteristics and Traits *

Note: Provide information about your pet’s breed, size, temperament, etc.

Pet #2: Given Name *

Pet #2: Type of Pet *

Pet #2: Characteristics and Traits *

Note: Provide information about your pet’s breed, size, temperament, etc.

Pet #3: Given Name *

Pet #3: Type of Pet *

Pet #3: Characteristics and Traits *

Note: Provide information about your pet’s breed, size, temperament, etc.

Pet #4: Given Name *

Pet #4: Type of Pet *

Pet #4: Characteristics and Traits *

Note: Provide information about your pet’s breed, size, temperament, etc.

Pet #5: Given Name *

Pet #5: Type of Pet *

Pet #5: Characteristics and Traits *

Note: Provide information about your pet’s breed, size, temperament, etc.

Pet #6: Given Name *

Pet #6: Type of Pet *

Pet #6: Characteristics and Traits *

Note: Provide information about your pet’s breed, size, temperament, etc.

Features of the Home

Please indicate the various features and characteristics of your home, and where requested, provide additional information.

Please indicate the type of home that you reside in *

Single Family Dwelling
Townhouse/Duplex
Condominium
Apartment

Please indicate if you are able to provide a private bathroom for the exlusive use of a student. *

No, bathroom(s) shared by other residents in the home
Yes, a private bathroom may arranged subject to availability

Available Bedrooms in the Home

Please indicate the number of bedrooms available in your home, and where requested, provide information about each.

Total number of bedrooms in the home

1
2
3
4

Bedroom #1: Type of Bed *

Single
Twin
Double
Queen
King
Bunk Bed
Futon

Bedroom #1: Type of Flooring *

Bamboo
Carpet
Cork
Hardwood
Laminate
Porceline or Ceramic Tile
Stone or Natural Tile
Vinyl

Bedroom #1: Does the room currently include a closet, dresser and desk? *

Yes, the room includes a closet, dresser and desk
No, the room is missing one or more items

Bedroom #2: Type of Bed *

Single
Twin
Double
Queen
King
Bunk Bed
Futon

Bedroom #2: Type of Flooring *

Bamboo
Carpet
Cork
Hardwood
Laminate
Porceline or Ceramic Tile
Stone or Natural Tile
Vinyl

Bedroom #2: Does the room currently include a closet, dresser and desk? *

Yes, the room includes a closet, dresser and desk
No, the room is missing one or more items

Bedroom #3: Type of Bed *

Single
Twin
Double
Queen
King
Bunk Bed
Futon

Bedroom #3: Type of Flooring *

Bamboo
Carpet
Cork
Hardwood
Laminate
Porceline or Ceramic Tile
Stone or Natural Tile
Vinyl

Bedroom #3: Does the room currently include closet, dresser and desk? *

Yes, the room includes a closet, dresser and desk
No, the room is missing one or more items

Bedroom #4: Type of Bed *

Single
Twin
Double
Queen
King
Bunk Bed
Futon

Bedroom #4: Type of Flooring *

Bamboo
Carpet
Cork
Hardwood
Laminate
Porceline or Ceramic Tile
Stone or Natural Tile
Vinyl

Bedroom #4: Does the room currently include a closet, dresser and desk? *

Yes, the room includes a closet, dresser and desk
No, the room is missing one or more items

Smoking and/or Vaping Preferences

It is important for us to understand your preferences related to smoking and/or vaping in your home or on your property.

Please indicate your preference related to smoking and/or vaping in your near your home. *

Smoking and/or vaping is not allowed
Smoking and/or vaping allowed outside only
Smoking and/or vaping is allowed inside

Meal Type Preferences

Respecting dietary preferences and/or specific food requirements is a significant consideration when placing a student in a host family. Your ability to accommodate, where possible, is greatly valued.

Are you able to accommodate certain restricted and/or speciaty diets? *

Yes, I/we can accommodate certain restricted diets
No, I/we cannot accommodate any restricted diets

Note: Restrictive diets include, but are not limited to the following: diabetic-friendly, gluten-free, halal, high-protein, kosher, lactose-free, nut-free, pescetarian, pork-free, shellfish-free, vegan, and vegetarian.

Gender & Age Preferences

Identifying your gender and age preferences is important when considering potential students for your home.

Please indicate your general gender preference for students? *

No preference related to student gender
I/we prefer female students only
I/we prefer male students only

Please indicate your general age preference for students? *

No preference related to student age
I/we prefer high school aged students (14-18 years)
I/we prefer university/college aged students (19+ years)

Note: We generally would not accommodate any student younger than 14 years of age unless they are accompanyied by a parent or legal guardian.

Hosting Experience

Please indicate your history hosting students in your home, and where requested, provide information about your experience.

Have you had previous hosting experience? *

No, I/we have not had previous hosting experience
Yes, I/we have previous hosting experience

Note: We encourage and support the participation of new families who have no previous hosting experience, as well as value those with past experiences.

Hosting Motivation

Understanding your motivation for hosting students in your home is important when considering a potential placement.

Briefly describe your motivation for hosting students in your home. *

Source of Referral

It is important for us to know how you learned about our company and the services we provide.

Please indicate how you learned about our company and/or the services we provide. *

Family Member
Friend or Neighbour
School Representative
School Newsletter/Website
Internet Search
Social Media
Community Bulletin Board
Flyer Delivered to Home
Newspaper Ad

Please provide the name of the referring person:

Availabilty

Please indicate your preferred time of day for our representative to connect with you and indicate your preferred start date for hosting an FCI student, if approved.

What time of day is best for us to connect with you?

I/we prefer mornings (9:00am-12:00pm)
I/we prefer afternoons (12:00pm-6:00pm)
I/we prefer evenings (6:00pm-8:00pm)

Note: We will make every effort to accommodate your preferred time of day.

When are you available to start hosting with FCI, if approved?

Note: Subject to your successful completion of our host family screening process

Your Declaration of Intent and Accuracy of Profile

By submitting this application you are a affirming that the information entered is an accurate reflection of you, your family, and your home. Additionally, you are affirming your intention to always act in an ethical, respectful and caring manner.

Welcome Hosts!
Hosting Responsibilities
Becoming an FCI Host
Host Family Application

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FIRST CHOICE INTERNATIONAL PLACEMENT INC.
233 1st Street West, Suite 340
North Vancouver
British Columbia
V7M 1B3

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