Student Application Please fill in as much information as possible. Student InformationWhile in Canada Student Will Be Attending(Required)Choose One to Continue ApplicationHigh SchoolUniversityPlease note: we are not accepting non-custodian high school students at this time.High School Student(Required) I understand that this application is only for high school students who need custodianship and that the student listed on the application is attending a high school in Canada.Confirm this application is for a high school student to continue.University Student(Required) I understand that this application is only for university students and that the student listed on the application is attending a university in Canada.Confirm this application is for a university student to continue.Legal Student Name(Required)Please double check spelling matches EXACTLY what appears in the student’s passport. The name provided here is used on legal paperwork. A typo or discrepancy between what is in the student’s passport may result in delays and/or additional fees to replace documents. First Middle Last Preferred NameIf different than legal name. Student Email(Required) Enter Email Confirm Email Student Phone(Required)✓ Valid number ✕ Invalid numberStudent Gender(Required) Student Date of Birth(Required) MM slash DD slash YYYY What country was the student born in?(Required) AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Has the student lived in any other countries? Please list them.(Required) What languages does the student speak?(Required) Is this the student's first time in Canada?(Required) What are the student's interests and hobbies?(Required)Does the student have any dietary restrictions? Check all that apply.(Required) Vegetarian Vegan Gluten Free Celiac Dairy Free None Does the student have any other dietary restrictions not listed above or is additional information needed about the student's dietary restrictions? Are there any medications the student is currently taking or expected to take while in Canada?(Required) Has the student ever been in, or is currently in, any kind of therapy? Will they be in any kind of therapy while in Canada?(Required) Does the student smoke?(Required)Please note: smoking is not permitted in our program.Choose OneNoYesAre there any other allergies, medications or health concerns we should be aware of?(Required)For Host FamilyStudent’s need to provide 1-3 photos of themselves and a letter that will be given to their host family before they arrive. If the student needs more time to prepare these, check the box below to provide these at a later date.Provide Photos and Letter at a Later Date Provide Photos at a Later Date Provide Letter at a Later Date Student Photo(Required)Please provide 1-3 photos of the student.Accepted file types: jpg, png, pdf, heic, jpeg, Max. file size: 10 MB.Student Photo 2Accepted file types: jpg, png, pdf, heic, jpeg, Max. file size: 10 MB.Student Photo 3Accepted file types: jpg, png, pdf, heic, jpeg, Max. file size: 10 MB.Host Family Letter(Required)Please provide a letter from the student to their host family.Accepted file types: doc, docx, pdf, Max. file size: 10 MB.Arrival InformationAnticipated Arrival Date(Required) MM slash DD slash YYYY Homestay Placement to Start(Required) MM slash DD slash YYYY Anticipated End Date(Required) MM slash DD slash YYYY School District where the Student Will Attend School(Required)Choose OneAbbotsfordLangleySurreyMaple RidgeCoquitlamThunder BayOtherUnknownOther:(Required) Name of the School the Student Will Attend(Required) Grade the Student Will Be In(Required) Airport ServicesAirport Pick Up(Required)Choose OneYesNoAirport Drop Off(Required)Choose OneYesNoFlight DetailsFlight Purchased Student has not purchased a flight yet. Airline(Required) Flight Number(Required) Flight Date(Required) MM slash DD slash YYYY Flight Time(Required) Hours : Minutes AM PM AM/PM Agency InformationAre you working with an agency?(Required)Choose OneYesNoAgency Name(Required) Agent Name(Required) First Last Agent Phone(Required)✓ Valid number ✕ Invalid numberAgent Email(Required) Enter Email Confirm Email Contact InformationPlease provide contact information of who we should contact about this application. If you are a parent or guardian, please provide your information to receive updates about this application.Contact University Student I am applying as a university student and would like you to contact me about my application. Contact Name(Required) First Last Contact Phone(Required)✓ Valid number ✕ Invalid numberContact Email(Required) Enter Email Confirm Email Relationship to Student(Required) Additional InformationPlease use this section to tell us about any special requests/concerns the student has:(Required)Please send a copy of this application to:If you want to receive a copy of this application for your records, please select who you would like this sent to. The agency will automatically receive a copy. Student Email Contact Email Other Email Email To Send Copy of Application To(Required) Enter Email Confirm Email CommentsThis field is for validation purposes and should be left unchanged.
