Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Introduction - Step 1 of 5 Thank you for your interest in becoming a Homestay Host with CLLC. Have you contacted our Homestay Coordinator for more information before completing this application? If yes, please continue with your application. We will respond to all applications as quickly as possible. If No, please contact info@cllc.ca before completing this application. NextFirst Name *Date of Birth *Phone Number *Last Name *OccupationEmail *Secondary Contact First Name *Date of Birth *Phone Number *Last Name *OccupationEmail *Are there additional people living in your household?YesNoHave you hosted students before?YesNoHow did you hear about CLLC?How did you hear about CLLC?Referred by a FriendKijiji AdOnline SearchDo you have pet?YesNoWhy are you interested in hosting for CLLC?Why are you interested in hosting for CLLC?Learn about new culturesIncrease incomeMeet new friendsWhat are your hobbies?SportsWatchingPlaying GamesSpending Time with FamilyFitnessPhotographyShoppingCookingMusicReadingTravelingWatching MoviesOtherNextStreet Address *City *Province *Select OptionOntarioNova ScotiaQuébecNumber of Student Rooms Available *Select012345Room DescriptionPostal Code *Travel time to CLLC on Public Transit(in Minutes)0-1516-3031-4546-6060+Choose one of our beautiful cities *HalifaxOttawaTorontoHomestay DescriptionHow Many Rooms Do You Have Available: Room 1 2 3 *1 Room2 Room3 RoomStudents Rooms must be fully furnished, please select the appropiate description: Fill Room 1 Information: BedSingleDoubleKingQueenWindow SizeSmallMediumLargeMore than 1Room LevelBasementFirst FloorSecond FloorLampAvailableNot AvailableDresser3 Drawers4 DrawersNot AvailableTV in RoomAvailableNot AvailableRoom SizeSmallMediumLargeExtra LargeWashroomSharedPrivateNight StandAvailableNot AvailableClosetAvailableNot AvailableDesk With ChairAvailableNot AvailableFill Room 2 Information: BedSingleDoubleKingQueenWindow SizeSmallMediumLargeMore than 1Room LevelBasementFirst FloorSecond FloorLampAvailableNot AvailableDresser3 Drawers4 DrawersNot AvailableTV in RoomAvailableNot AvailableRoom SizeSmallMediumLargeExtra LargeWashroomSharedPrivateNight StandAvailableNot AvailableClosetAvailableNot AvailableDesk With ChairAvailableNot AvailableFill Room 3 Information: BedSingleDoubleKingQueenWindow SizeSmallMediumLargeMore than 1Room LevelBasementFirst FloorSecond FloorLampAvailableNot AvailableDresser3 Drawers4 DrawersNot AvailableTV in RoomAvailableNot AvailableRoom SizeSmallMediumLargeExtra LargeWashroomSharedPrivateNight StandAvailableNot AvailableClosetAvailableNot AvailableDesk With ChairAvailableNot AvailableIs Smoking permitted?YESNOIn HomeYESNOOutside the HomeYESNOIs Alcohol permitted?YESNOPlease rate your Homestay based on our Quality Assurance Rating System: ( Note: 1= Poor, 10= Outstanding ) Distance to Campus12345678910Food Quality12345678910Interaction with Students12345678910Cleanliness12345678910Home Quality12345678910Sensitivity to Needs12345678910Hosting Preference: Who would you prefer to host?MaleFemaleEitherWhat age range would you prefer to host?15-2021-3031+Doesn't MatterNextFirst Reference: Name *Email Address *Phone *RelationshipSecond Reference: Name *Email Address *Phone *RelationshipThird Reference: Name *Email Address *Phone *RelationshipNextHomestay Resident Suitability Declaration All accredited institutions of languages Canada(LC) are committed to proving their students a secure and safe environment in homestay. To comply with Languages Canada Standards, institutions that wish to place students in homestay must require Criminal Record Checks(CRCs) from all individuals normally residing in the home who have reached the age of majority. This declarations does not replace the CRC,except as an interim measure.for those memebers who wish to place students in homestay prior to the required CRC documents being received by the institution, this form must be use, and it must be received by the homestay coordinator at the LC institution before any students are placed in home. Full Name *Date of BirthAddress *Have you ever Been convicted of any offence against a minor?YESNOHad a minor removed from your care by order of a court?YESNOBeing disqualified from acting as a foster parent?YESNOBeen proven negligent while supervising minors under 18 years of age on activites /courses organized by any other organization?YESNOI agree the following conditions: I will not engage in any sexual conduct with the student or sexually harass or use any position of authority as an adult with the student in an inappropriate manner. I agree that if i am convicted of an offence I shall report it within 24 hours to the LC institution. I hereby declare that the foregoing information is true and complete to my knowledge. I understand that a false statement may disqualify me from providing homestay accomodation. I agree to apply for a Criminal Record Check(CRC) from the appropriate authorities wwithin seven days of completing this suitability Declartion. I further agree to submit the completed CRC to the LC institution upon receipt of the CRC. Full Name *E-Signature *Date of BirthSubmit
