IHPS Housing Application

I am a (n)

First Name:		Last Name:
Date of Birth: (Month/Day /Year)		Age	Male/Female:
Passport #
Permanent Address
City
State/Province		Country
Postal Code:		Telephone number:
Fax:		Email:
In Case of Emergency, Please Notify:
Name:		Telephone number:
Email:

For Agent Use Only:
Name of Agency:		Agent Name:
Telephone number:		Country:
Fax:		Email:

Arrival Information:
Date of Arrival:		Arrival Time:
Flight Number:		Airline:
Airport:		Do you need airport pick up?	($100 Extra fee)

Accommodations Requested:

Requested check-IN date		Check-out date
Name of School you will be attending		or Address of Internship:
Are children in the home acceptable?		Are animals in the home acceptable?	**Please note: Many Hosts have at least one animal in their home.

Personal Information:
Your English ability is
Other Languages you speak:		Will you have a car in the US?
List any hobbies and/or interests		Major of study
Do you have any allergies or medical concerns?		If yes, please list:
Do you take any medication?		If yes, please list:
Are you in good health?		Do you smoke cigarettes?	(Please note: There is a no smoking policy for all homestays)
If you do smoke, do you agree not to smoke in or around your Host's home?

Describe your family life including information about your parents and siblings: (Required information)
Have you traveled to the US before? Where have you traveled in the world? Please tell us about your experience.


I have read, understand and ACCEPT the IHPS Housing Agreement.	(please print a copy for your records)	I have read, understand and ACCEPT IHPS Policy on "Cancellation" and "Termination"

Date:		Electronic Signature:
Parent/Guardian Signature if applicant is under the age of 18 years of age:
Date:		Signature:

To fax or mail your application, please download a PDF copy here
Student Application