WHICH GEOS SCHOOL WOULD YOU LIKE TO BE A HOSTFAMILY FOR?
Choose School Here:
USA
Boston - GEOS Language Institute
New York - GEOS Language Institute
San Francisco - GEOS English Academy
Costa Mesa - GEOS English Academy
Torrance - GEOS English Academy
Honolulu - GEOS Language Institute
Canada
Ottawa - GEOS Language Academy
Toronto - GEOS Language Academy
Montreal - GEOS Language Academy
Calgary - GEOS Language Academy
Vancouver - GEOS Language Academy
Victoria - GEOS Language Academy
YOUR LAST NAME:
YOUR FIRST NAME:
GENDER:
CHOOSE HERE:
Male
Female
DATE OF BIRTH:
DAY:
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MONTH:
January
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December
YEAR:
1920
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ADDRESS (including zip code):
E-MAIL ADDRESS:
HOME TELEPHONE NUMBER:
MOBIL TELEPHONE NUMBER:
OCCUPATION:
WHICH STATEMENT BEST DESCRIBES YOU?
CHOOSE HERE:
I'm single with no children at home
I'm single with young children at home
I'm single with teenage children at home
I'm single with adult children at home
I'm married with no children at home
I'm married with young children at home
I'm married with teenage children at home
I'm married with adult children at home
I live with my partner and no children at home
I live with my partner and with young children at home
I live with my partner and with teenage children at home
I live with my partner and with adult children at home
TELL US ABOUT WHO LIVES WITH YOU
My
CHOOSE PERSON #1:
Wife
Husband
Domestic Partner
, named , birthdate
DAY:
01
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MONTH:
January
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December
YEAR:
1920
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My
CHOOSE PERSON #2:
Son
Daughter
, named , birthdate
DAY:
01
02
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MONTH:
January
February
March
April
May
June
July
August
September
October
November
December
YEAR:
1920
1921
1922
1923
1924
1925
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2005
My
CHOOSE PERSON #3:
Son
Daughter
, named , birthdate
DAY:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
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31
MONTH:
January
February
March
April
May
June
July
August
September
October
November
December
YEAR:
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
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1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
My
CHOOSE PERSON #4:
Son
Daughter
, named , birthdate
DAY:
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
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19
20
21
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25
26
27
28
29
30
31
MONTH:
January
February
March
April
May
June
July
August
September
October
November
December
YEAR:
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1948
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
WHAT IS THE MAIN LANGUAGE SPOKEN IN YOUR HOME?
WHAT OTHER LANGUAGES ARE SPOKEN IN YOUR HOME?
DO YOU HAVE ANY PETS?
CHOOSE HERE:
No pets
Yes, I have a dog/dogs living inside
Yes, I have a dog/dogs living outside
Yes, I have a cat/cats living inside
Yes, I have a cat/cats living outside
Yes, I have both a dog(s) & a cat(s) living inside
Yes, I have both a dog(s) & a cat(s) living outside
Yes, I have other pets
TELL US ABOUT YOU AND YOUR FAMILY'S HOBBIES AND INTERESTS
HAVE YOU EVER HOSTED AN INTERNATIONAL STUDENT?
CHOOSE HERE:
No, this is my first time
Yes, I have hosted an international student
TELL US WHICH TYPE OF STUDENT YOU PREFER
CHOOSE HERE:
Female only
Male only
Male or female
TELL US WHY YOU ARE INTERESTED IN HOSTING INTERNATIONAL STUDENTS
CAN STUDENTS SMOKE IN THE HOUSE?
CHOOSE HERE:
No smoking
Yes, smoking permitted
CAN STUDENTS DRINK ALCOHOL IN THE HOUSE?
CHOOSE HERE:
No alcohol
Yes, alcohol permitted
HOW MANY STUDENTS CAN YOU HOST IN SEPARATE ROOMS?
CHOOSE HERE:
1 student
2 student
3 student
4 student
WHAT LENGTH OF TIME DO YOU WISH TO HOST A STUDENT?
CHOOSE HERE:
1 month or less at a time
1 ~ 3 months at a time
3 ~ 6 months at a time
OCCASIONALLY STUDENTS HAVE DIETARY RESTRICTIONS FOR HEALTH OR RELIGIOUS REASONS. WOULD YOU BE WILLING TO HOST SUCH A STUDENT?
CHOOSE HERE:
Yes
No
DO YOU AGREE TO PROVIDE 2 MEALS (BREAKFAST & DINNER) SCHOOL DAYS AND THREE MEALS AT ALL OTHER TIMES?
CHOOSE HERE:
Yes
No
DO YOU AGREE TO PROVIDE A ROOM FOR A STUDENT WHICH HAS A BED, A CLOSED/DRESSER, DESK AND ACCESS TO A BATHROOM?
CHOOSE HERE:
Yes
No
WHICH TRAIN OR SUBWAY STATION IS CLOSEST TO YOUR HOME?
WHAT ROUTE WOULD THE STUDENT TAKE FROM YOUR HOME TO GEOS?
HOW LONG WOULD THE COMMUTE TAKE, DOOR TO DOOR, DURING NORMAL WEEKDAY HOURS?
PLEASE PROVIDE THE NAME AND TELEPHONE NUMBER OF 3 LOCAL REFERENCES:
DO YOU HAVE ANY ADDITIONAL QUESTIONS OR COMMENTS?
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