English Language School - The Place to Learn English!

Online Application for Host Family

* Address

* City

* State

* Zip Code

* Family/Last Name

* First Name

Middle Name

* Email

* Day Time Tel

* Evening Time Tel

Primary language spoken at home:

Secondary language spoken at home:

List all pets:

Which pets are allowed indoors?

* Do you host students from other schools?

Yes

If yes, which school?

* Interests or activities engaged in as a family or with students:

Type of Home:

No. of bedrooms:

No. of bathrooms:

No. of bedrooms for hosting:

Other amenities (i.e., pool, gym, etc.):

Student's bathroom:

* Please list student's room amenities (i.e., telephone, television, computer, etc.):

Any additional information about your house:

Public transportation accessible from your house:

* Campus:

Los Angeles

Irvine

Pasadena

Estimated commuting time to campus, including walking and wait time by Google:

(minutes: Numeric only) Numeric only

* Homestay Option:

$ /month

Gender preference:

* May students prepare their own food?

Yes

Smoking policy:

* Requirements related to religious practice:

* Any additional requirements, preferences, rules, etc.:

* I have read and agreed to POLY's Applicant's Statement