Host Reference Form
Before completing the Reference form, please read the information about the Homestay Program.

Homestay Applicant Name:

Name of Person Providing Reference:

Home Phone Number (with area code):

Work Phone Number (with area code):

Email: 

Relationship to Applicant:

How long have you known the applicant?

How would you describe the applicant in terms of personality?

How would the applicant handle a difficult interpersonal problem with any of the following: friend, spouse and/or family member, their children, cross-cultural?

Would you recommend the applicant for the Homestay Program?

Do you have any reservations?

Any additional comments:

Thank you for your time and for providing this information in support of the Applicant.

 

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. 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:Telephone: (204) 474-8339, 331 Dafoe Library, Winnipeg, Manitoba, Canada, R3T 2N2

Date: