Form | Independent Student

Host Mother First Name

Host Mother Last Name

Host Father First Name

Host Father Father Last Name

Address:Unit/House Number & Street

Address:City

Address: Province

Address: Postal Code

Primary Email Address

Home Phone #

Cell Phone #

Host Mother Work Phone #

Host Father Work Phone #

Host Mother Occupation

Host Father Occupation

“In the below field, please list all people living in the home, including mother, father, and any other international students/renters/boarders.”

We require... Name/Relationship/Birthdate (D-M-Y)/Gender/Occupation (Student or Work) and 3 interests or hobbies for each person.

Family details here

Will the student need to share a room? (same gender 2 beds)

YES

If "Yes" with whom?

Do you have any indoor pets? Please indicate breed, short haired, long haired

Does anyone in your home smoke or vape? If yes please tell us if they smoke indoors or outside

Have you hosted before? If Yes tell us what you enjoy about hosting

Transportation: How will your student get to school? How far is it and what is the cost if any?

Tell Us About Your Family-What is your daily routine? What values do you hold important as a family? Why would you like to host? Personalities of family members?Does anyone have a special diet? Do you have concerns about other religions?

In addition to this form please email 3 pictures- outside front of your home/ a family picture/ an image of the students bedroom. Please also email a short greeting letter to your student. SEND EMAILS TO neilhosler07@gmail.com

Upon completion and submission of your application ISSA-Canada will email you additional Host Family Agreement Forms to finalize your candidacy as a host family.

In addition to paperwork you will be contacted by a Local Student Support Coordintor in your area to set up an in person home visit.