San Diego Homestay

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Student Application

This application is for international students seeking homestay in San Diego. Please fill out as many fields as possible to ensure our staff can match you with the best host family. Be sure your email is correct, San Diego Homestay staff will use the email address you provide on this application to contact you.

If you are a host family, please see our host family application. Students or schools with a question or comment for San Diego Homestay may contact our office at (858)457-1322 or use our feedback form.

School and Program Name:

Start Date(YYYY/MM/DD):

End Date(YYYY/MM/DD):

First Name:

Family Name:

Date of Birth (YYYY/MM/DD):

Address:

City:

Country:

Postal Code:

Home Phone:
(city code - country code - number)

Fax Number:
(city code - country code - number)

Email Address*:

Emergency Name:

Emergency Number:

Arrival Date (YYYY/MM/DD):

Arrival Time:

Flight Number:

Airline:

Housing Information (Select all that apply)

Private bedroom (Breakfast and dinner included)

Shared bedroom (Breakfast and dinner included, subject to availability)

Rent a room in an American home (food not included)

Personal Information

Male

Female

Personality:

Shy

Outgoing

Other

Do you smoke?: Yes: | No:

Do you drink?: Yes: | No:

Transportation:

Public Transit

Rent a car

Purchase a car

Do you have any medical conditions that we should be aware of?:

Yes

No

If Yes, please explain :

Can you tolerate pets?:

Yes

No

If No, please explain :

Do you have any special requests?

(Maximum characters: 400)
You have characters left.

Please read and sign(type) your name below. Then press the "Submit" button

By typing your name below you hereby certify that the forgoing is true and correct to the best of your knowledge and agree, to hold harmless San Diego Homestay, it's owners and agents, from any claim by me for loses, costs, expenses, damages or injuries to persons or property, whether direct or in direct, or consequential, arising in any way out of any housing arrangement made between myself or anyone representing me and San Diego Homestay, including any activity related to such housing arrangement or agreement. Please note that there is a non-refundable $275 placement fee. By submitting this application you agree to pay all fees directly to the homestay agency upon placement.

Signature (Name)*:

Date:

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Student Application