Thank you for your interest in becoming an FCI Host Family. There is a three-step process to become approved for hosting international students or visitors through FCI:

1. You must complete and submit the Host Family Application below.

2. You must arrange to complete a Criminal Record Check with your local law enforcement authority.

3. Upon completion of Step #1 and #2, you must then request a Site Visit and Interview with an FCI Placement Specialist.

Should you have questions at any time during the three-step process please do not hesitate to contact us.

Primary Contact Information

Please note that the symbol [ * ] indicates a required field. Applications submitted without this information cannot be processed.
Surname:*	Given Name(s):*
Street Address:
Mailing Address:
City:	Prov: Postal:
Home Phone:*	Business Phone:
Email:*
Occupation:
Referred By:

Additional Adults Living in the Home

Please list all other adults living in the home and indicate their relationship to the primary contact.
Adult #2:
Surname:	Given Name(s):
Relationship:	Gender: select=> Female Male
Occupation:
Adult #3:
Surname:	Given Name(s):
Relationship:	Gender: select=> Female Male
Occupation:
Adult #4:
Surname:	Given Name(s):
Relationship:	Gender: select=> Female Male
Occupation:

Children and Teens Living in the Home

Please list all children and teens living in the home and provide their year of birth.

Given Name: Gender: select=> Female Male Year of Birth:

Given Name: Gender: select=> Female Male Year of Birth:

Given Name: Gender: select=> Female Male Year of Birth:

Given Name: Gender: select=> Female Male Year of Birth:

Given Name: Gender: select=> Female Male Year of Birth:

Features of Your Home

Please describe the type of home that you live in.
Single Family Dwelling	Apartment
Condominium	Townhome/Duplex

Please select the various features of your home.
Multiple Bathrooms	Second Kitchen	Games Room
Large Yard	Hot Tub	Exercise Bike
Patio Deck	Swimming Pool	Treadmill

Please select the instruments that may be available to students (with permission).
Acoustic Guitar	Regular Piano	Organ
Electric Guitar	Electric Piano	Violin
Drums	Grand Piano	Wind Instruments

Will the student have exclusive use of a bathroom in your home? Yes No

If "No", please indicate who else would be using the same bathroom.

Features of Your Available Bedrooms

How many other bedrooms are available for students in your home?
	One	Two	Three	Four

Bedroom #1 Features:
Type of bed: Single Double Bunk or Twin Beds Futon Hide-away	Included items: Desk Dresser Closet Clock Radio	Internet Access Telephone TV/VCR/DVD Ensuite
Comments: (i.e. size?, natural lighting?, location?, etc.)

Bedroom #2 Features:
Type of bed: Single Double Bunk or Twin Beds Futon Hide-away	Included items: Desk Dresser Closet Clock Radio	Internet Access Telephone TV/VCR/DVD Ensuite
Comments: (i.e. size?, natural lighting?, location?, etc.)

Bedroom #3 Features:
Type of bed: Single Double Bunk or Twin Beds Futon Hide-away	Included items: Desk Dresser Closet Clock Radio	Internet Access Telephone TV/VCR/DVD Ensuite
Comments: (i.e. size?, natural lighting?, location?, etc.)

Bedroom #4 Features:
Type of bed: Single Double Bunk or Twin Beds Futon Hide-away	Included items: Desk Dresser Closet Clock Radio	Internet Access Telephone TV/VCR/DVD Ensuite
Comments: (i.e. size?, natural lighting?, location?, etc.)

Hobbies and Interests

Please indicate the hobbies and intereststs for you and/or your family.

Pets

Please provide information on the pets that live in your home.

Smoking Preferences

Please indicate your preferences pertaining to students smoking in your home. Smoking is not allowed Smoking allowed outside only Smoking is allowed

Meal Considerations

Please select the type(s) of special meals you could prepare if requested. Halal (What is Halal?) Vegetarian

Transit Times From Your Location

Please indicate the approximate transit times from your home.
Walking distance to closest bus stop or transit station:	Minutes
Transit distance to the closest public library:	Minutes
Transit distance to the closest shopping mall:	Minutes
Transit distance to the closest recreation centre:	Minutes
Transit distance to downtown Vancouver:	Minutes
Transit distance to closest cinema:	Minutes

Previous Hosting Experience

Have you had previous hosting experience? Yes No

If "Yes", please identify name of agency and/or school.

What is your motivation for hosting students in your home?

Please outline your reasons for hosting.

Message to Students/Visitors

What would you like to share with students/visitors about you and/or your family?

Preferred Type of Student/Visitor

Please select the type(s) of students/visitors that you are willing to accomodate in your home.
Female(s) 8-12 Yrs. Female(s) 13-15 Yrs. Female(s) 16-18 Yrs. Female(s) 19-25 Yrs. Female(s) 25+ Yrs. Young Couple(s) Parent with Child	Male(s) 8-12 Yrs. Male(s) 13-15 Yrs. Male(s) 16-18 Yrs. Male(s) 19-25 Yrs. Male(s) 25+ Yrs. Mature Couple(s) Small Family

Availability

Please indicate when you would be available to start hosting students? Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2005 2006 2007 2008 2009 2010

Please indicate the best time of day to arrange an interview and inspection of your home.

select=> Morning Afternoon Evening