Homestay Host Application

 

Please read Interested in Hosting before submitting your application.

1. General information - Primary contact person

Family name:

First name:

Address:

Postal Code:
Primary Email:
Alternate Email (optional):
Home Phone :

Work Phone :

Cell number :


2. Resident members in your home, including yourself, family, other students or boarders

Primary Contacts Name:
Date of Birth - Year: Month:
Day:
Occupation: Schedule:


Name:
Relationship to you:
Date of Birth - Year: Month:
Day:
Occupation: Schedule:


Name:
Relationship to you:
Date of Birth - Year: Month:
Day:
Occupation: Schedule:


Name:
Relationship to you:
Date of Birth - Year: Month:
Day:
Occupation: Schedule:


Name:
Relationship to you:
Date of Birth - Year: Month:
Day:
Occupation: Schedule:


3. Information about you and your family

What languages are spoken in the home?

Have you or members of your family travelled or lived outside of Canada?
If yes, to what countries and for how long?

What are the interests of the adults in the household?

In what kind of leisure activities do family members participate?

What kind of leisure activities can you offer a student?

Does anyone in the family play a musical instrument?
If yes, what instrument(s)?

What are the mainstays of your family's diet?

Please note any dietary practices or restrictions followed by your family

Do you have pets?
If yes, what kind and how many?

Are there any smokers living in your home?
If yes, do they smoke inside your home?
Would you accommodate a student who smokes?
Would you accept a student who was
willing to smoke outdoors only?


4. Information about your house

Please describe your home (number of bedrooms, washrooms, levels)

Please describe the student's room (location in home, size, furniture, etc.)
Please note: if the student's room is located in the basement, you must provide the window's measurements.

Are there operating smoke detectors on each level of your home?
Do you have a fire extinguisher installed in your home?
If yes, Where is it located?
Do you have a washer and dryer?
Do you have high speed internet? Wireless
Is there internet access in the student's room?

Regarding insurance, does your property and/or
fire insurance cover a student's belongings?

Does your insurance include liability for a student?
How long does it take to walk from your home to the bus stop?

Please use the Navigo website to answer the following questions:

All times should be based on a 8:30 am University arrival time, please include walking time in your response.

What is the Bus Route Number ?

How long a bus trip is it to the university?
How long a bus trip is it to downtown?
Will the student need to transfer buses?
How many buses to the university?
Do these buses run on weekends?
If no, what is the alternative?


5. Homestay  Experience

Have you had a Homestay student before?
If yes, please indicate the Homestay program, when involved, include the name and phone number of the Homestay Coordinator (U of W, U of M, IEP, high school).

Can we contact this person for a reference?
Why do you want to have a student live with your family?


How did you find out about our program?

Please indicate by what date you are available to receive a student:

How many students do you wish to accommodate?
What gender?
Would you prefer a student who is independent or someone who enjoys and anticipates spending time in activities with your family?

Additional comments:


6. References

Please provide the names of three references from friends, supervisors or co-workers (past or present), and for couples, three references per person. These references must  fill out the online Reference Form and submit it on your behalf.

Please copy and paste the text in the box below in an email to your reference.

http://www.umanitoba.ca/student/elc/homestay/reference.html

 

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7. Winnipeg Police Information Check

  • We require Host applicants to submit a Winnipeg Police Information Check with Vulnerable Sector Search from the Winnipeg Police Service for each resident over the age of 18. 
  • The Information Check  must include the Vulnerable Sector Search.  
  • The Information Checks without the Vulnerable Sector Search will not be accepted and it will be the responsibility of the applicant to request a new check from Winnipeg Police Service at their own cost. 
  • The Homestay office does not accept Information Checks from any third parties, companies or other police services.
  • Information Checks must be submit to the Homestay office by either email, regular mail or in person.  Homestay staff  must see the original(s) and we will keep a copy for our records.
  • New Host applicant's Information Checks must be dated no older than one (1) year from the date of application.
  • The Homestay office will require an updated Information Check every five years.

You can choose to apply online or in person only through the Winnipeg Police Service. Please visit Winnipeg Police Service website for more information.  


8. Please check in support of the following:

I have read and understand the Homestay Pledge.
I will provide a Winnipeg Police Information Check with the Vulnerable Sector Search for each resident over the age of 18
I will comply with the guidelines for window size requirement and smoke alarms

I will have three references submitted directly to the Homestay program. Additional references will be submitted if requested by  Homestay staff

I understand that the Homestay Program will not honour requests that are discriminatory

I have read and understand the written information provided and agree to abide by the terms of that information. I declare that all the information provided in this application is accurate, and understand that any misinformation will invalidate this application. I understand that if I do not comply with any of the items on the above checklist, I cannot be considered for a placement of a Homestay student.

This information is being collected under the authority of The University of Manitoba Act. It will be used for the purpose of making a suitable match between student and family. Certain information will be shared with the student and/or agent. It will not be used or disclosed for other purposes, unless permitted by The Freedom of Information and Protection of Privacy Act. Your personal information is protected by the Protection of Privacy provisions of The Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of your personal information, contact the FIPPA/PHIA Coordinator's Office, University of Manitoba Archives & Special Collections: FIPPA/PHIA Coordinator's Office, Telephone: (204) 474-8339, 331 Dafoe Library, Winnipeg, Manitoba, Canada, R3T 2N2

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