Homestay Student Application

IMPORTANT REMINDERS FOR STUDENT APPLICANTS

1. Spaces are still available and we are still accepting applications for Winter 2018.

2. After you have submitted your form, you will receive a confirmation email from our office within two (2) business days. If you do not receive this confirmation, please email homestay@umanitoba.ca.

3. Important Dates

Documents, Fees and Move-In Dates Winter 2018
Application & Application Fee Currently accepting, application fee due with application
Homestay Fee, Visa copy, Arrival information December 1, 2017
Move-in Date* January 1, 2018
*Students who arrive before the Move-in date will need to find their own pick-up and accommodations until the Move-in date.

4. Please read Deferrals and Refund Policies regarding fees and Important information regarding booking flights, spouse/relatives, and health insurance.

5. Disclaimer

  • The ELC reserves the right to close the Homestay application at any time due to lack of Homestay spaces.
  • The University of Manitoba and the Homestay Program do not provide custodianship for underage students.

APPLICATION

Contact Information (all fields are required to process application)

Family Name:

First Name:

English Name Used:

Student's Home Street Address:

City:

Country:

Postal Code/Zip Code :

Student's Home Telephone Number (with area or country code):

Fax Number (with area or country code):

Student Number:

Email (required):

Student's Email (if different from above):


Personal Information:

Male Female

Date of Birth -
Year: Month: Day:

Single Married Spouse name

Will spouse accompany you :

Which Languages Do You Speak?

If you have lived or traveled outside of your country before, please
describe where and for how long:

Do you live ? Do you live ?

List the names and ages of your brothers and sisters:
Name:
Age: Gender:

Name:
Age: Gender:

Name:
Age: Gender:

Please specify any allergies (eg. Food, pet animals, medication, etc.) that
may affect your Homestay:

In case of an Emergency, who should we contact? (required fields)

Please describe any other medical and physical conditions which
may affect your Homestay:

Please indicate your level of English proficiency:

listening
speaking
reading
writing


Lifestyle

Please describe your hobbies and leisure activities. Please include as much detail as possible inorder to make the best possible match.:

Do you like outdoor activities?
Which ones do you like?

Do you like sports?
Which ones do you like?

Do you like the arts?
Which ones do you like?

Do you play a musical instrument?
If "yes" which one(s)?

Do you enjoy cooking?

If "yes" what do you like to cook?

Indicate the adjectives that best describe you:

shy and quiet adaptable and flexible independent
friendly and sociable neat and tidy studious
adventurous
Other

Are you a
Non-Smoker
Smoker
Would you accept a Homestay where you can only smoke outside? Yes No
Will you share a home with someone who smokes?

Would you like to live in a home with children? Yes No Maybe
If 'No' or 'Maybe', please describe your concerns:

Would you like to live in a home with pets? Yes No Maybe
If 'No' or 'Maybe', please describe your concerns:

Please tell us anything else about you that will help in placing you with a suitable family.

Describe your lifestyle. (ex: your personality, interests, and what you enjoy doing in your free time).

What are your hopes for your Homestay experience?


Dietary Requirements

Please describe the foods you are accustomed to eating:
Meat:
Never Sometimes Everyday
Vegetables:
Never Sometimes Everyday
Rice:
Never Sometimes Everyday
Pasta:
Never Sometimes Everyday
Fish:
Never Sometimes Everyday
Fruit:
Never Sometimes Everyday

Please describe any dietary restrictions:

Are you?
Vegetarian No pork diet (pig meat)


Comments Please describe any other concerns or questions which you have:


Study Program

English Language Centre
University of Manitoba Student (Undergraduate)
University of Manitoba Student (Graduate)
International College of Manitoba
Researcher
Visiting Scholar
Other


Term

Fall (September)
Winter (January)
Spring/Summer (May)


Visa Status

Student Visa/Permit
Visitors Visa
Visiting Scholar
Immigrant

Travel Information - NOTE: YOU MAY NOT MOVE IN HOMESTAY UNTIL JANUARY 1, 2018.

1. Departure From Home

Date: Airline:

Time: Flight #:

2. Arriving in Winnipeg

Date: Airline:

Time: Flight #:

Port of Entry to Canada Toronto Vancouver
Other:


I have:

read and understand the Homestay Pledge
read and understand the written information provided, and agree to abide by the terms of that information

kept a copy of this application for my own records

understood that the Homestay program will not honour requests for host families that are racially discriminatory.

By submitting the Homestay application, I understand I will not be given a Homestay placement until I have provided my arrival information and paid all Homestay fees of $3,150.00 CAD ($3,200 for ICM students). Homestay fees include: Application fee (non-refundable), Administrative fee, and Homestay Fee for the first 4 months (non-refundable after the student has moved into Homestay). Fees are subject to change without notice.

Date:

This information is being collected under the authority of The University of Manitoba Act. It will be used for the purpose of making a suitable match between student and family. Certain information will be shared with your Homestay family. It will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act. Your personal information is protected by the Protection of Privacy provisions of The Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of your personal information, contact the FIPPA/PHIA Coordinator's Office, University of Manitoba Archives & Special Collections: Telephone: 204-474-8339 331 Dafoe Library Winnipeg, Manitoba Canada, R3T 2N2.

Feel free to contact us at homestay@umanitoba.ca with any questions you might have.