Study English in Southern California! - POLY Languages Institute

Online Application for Host Family

* Address		* City		* State		* Zip Code

Primary language spoken at home:
Secondary language spoken at home:
List all pets:
Which pets are allowed indoors?
* Do you host students from other schools?	Yes No
If yes, which school?
Interests or activities engaged in as a family or with students:
Type of Home:
No. of bedrooms:
No. of bathrooms:
No. of bedrooms for hosting:
Other amenities (i.e., pool, gym, etc.):
Student's bathroom:
Please list student's room amenities (i.e., telephone, television, computer, etc.):
Any additional information about your house:
Public transportation accessible from your house:
* Campus:	Los Angeles Irvine Pasadena
Estimated commuting time to campus, including walking and wait time(minutes):

* Your monthly rent:	$ /month
Gender preference:
* May students prepare their own food?	Yes No
Smoking policy:
Requirements related to religious practice:
Any additional requirements, preferences, rules, etc.:

* I have read and agreed to POLY's Applicant's Statement