Student Homestay Application Form

1. Student Information


2. Parent / Guardian Information


Please Note:
Required for all students under the age of 18 years.

3. Accommodations & Flight Information


If your arrival time is not known, please contact Coquitlam College Homestay Department at least 10 days prior to your arrival.

4. Medical Insurance


Please Note:
Medical Insurance is Mandatory in Canada (Information available at the administration office).

Hobbies & Interests

Tennis
Reading
Swimming
Photography
Weight Lifting
Basketball
Bike Riding
Skiing
Track & Field

5. English Proficiency


6. Complete & Submit Application


* Required

By clicking Submit Application, you indicate that you have read and agree to the Coquitlam College Homestay Terms & Conditions.