EmailMe Form - Homestay Application

Transaction ID

I am/will be an F-1 student at ILI *

Yes

Full Name *

First Middle Last

Please write your name exactly as in your passport.

Gender *

Male

Female

Date of Birth

MM / DD / YYYY

Month / Day / Year
Minimum age for Homestay is 18 years. Applications for minors (under 18) are not accepted.

Country of Birth *

Native Language *

Phone *

Email *

Re-enter Email

Emergency Contact Name *

First Last

Emergency Contact Phone *

Expected First Day in Homestay *

MM / DD / YYYY

Month / Day / Year
Arrival of student at Homestay family's location has to be between 8am - 10pm the first day.

Expected Last Day in Homestay *

MM / DD / YYYY

Month / Day / Year

Airport Pickup? *

Yes

No

Arrival Airport *

Arrival Information

Airline, flight number, departing airport, arrival date & time

Upload Ticket

Please upload a copy of your airline ticket for your arrival in DC (1MB max. file size; pdf, png, jpg, gif, jpeg, tif file type only)

How is your English? *

Good

Fair

Poor

What are your hobbies? *

Do you prefer a homestay host with children? *

Yes

No

Is homestay with pets (animals) acceptable? *

Yes

No

Do you have any allergies? *

Yes

No

List your allergies *

How is your health? *

Good

Fair

Poor

Do you smoke? *

Yes

No

Health Insurance Company *

Health insurance is required by all Homestay students.

Policy Number *

Age Verification *

I verify that I am 18 years or older

Homestay Policies *

I have read and accept ILI's policies stated below.

I grant permission for ILI and/or the Homestay family to arrange for emergency medical treatment of the student during the period of Homestay. I waive all claims against ILI, its
employees and its Homestay families for any damage, loss, injury, accident, or illness occurring during the Homestay period.

I accept ILI's cancellation & refund policy: The Homestay Placement fee is non-refundable unless ILI is unable to place me with a Homestay family. Applicants wishing to withdraw
before the scheduled end date of Homestay are required to give ILI at least a one-week cancellation notice before their intended last day in Homestay. If the one-week cancellation notice is not given or the student does not start Homestay as scheduled, the charge of 1 week of Homestay at the current weekly rate is payable to ILI.

I agree to pay the $150 Homestay Placement Fee and I understand that ILI is not able to place me until the fee has been paid in full. I also agree to pay a $260 deposit with this application. Airport pick-up or drop-off is $100-175 depending on the airport. The late fee is $15 per week for payments 3 or more days past due.

Payment method *