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USA INTERNATIONAL, INC.

USA INTERNATIONAL, INC. INTERNATIONAL CULTURAL & SOCIAL DEVELOPMENT. 9614 NE 201st St. Bothell, WA 98011 Tel: 425-483-5974 Fax: 425-485-1891. E-mail: / URL: APPLICATION FOR STUDENT HOUSING. Page 1. 1. School Information: Approximate Arrival Date: _____. Quarter: Fall Winter Spring Summer Short-Term School: University of Washington - Main Campus Downtown Campus Bothell Picture Campus / Seattle University / Seattle Central College / City University / North Seattle College / Shoreline CC / Cascadia College / Bellevue College / South Seattle College / Highline College / Seattle Pacific University / ALPS /. Other: _____. 2. Basic Information: _____. Student Name: Mr. Ms. _____ English Name:_____. Birthday: ___/___/_____ Age: ____ Nationality: _____ Native language(s) : _____. Contact Information: Student Permanent Address: _____. ADDRESS / CITY.

Apr 24, 2018 · USA INTERNATIONAL, INC. INTERNATIONAL CULTURAL & SOCIAL DEVELOPMENT 9614 NE 201st St. Bothell, WA 98011 Tel: 425-483-5974 Fax: 425-485-1891 E-mail: info@ushomestay.com / URL: www.ushomestay.com Page 2 your preferences will be met.

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Transcription of USA INTERNATIONAL, INC.

1 USA INTERNATIONAL, INC. INTERNATIONAL CULTURAL & SOCIAL DEVELOPMENT. 9614 NE 201st St. Bothell, WA 98011 Tel: 425-483-5974 Fax: 425-485-1891. E-mail: / URL: APPLICATION FOR STUDENT HOUSING. Page 1. 1. School Information: Approximate Arrival Date: _____. Quarter: Fall Winter Spring Summer Short-Term School: University of Washington - Main Campus Downtown Campus Bothell Picture Campus / Seattle University / Seattle Central College / City University / North Seattle College / Shoreline CC / Cascadia College / Bellevue College / South Seattle College / Highline College / Seattle Pacific University / ALPS /. Other: _____. 2. Basic Information: _____. Student Name: Mr. Ms. _____ English Name:_____. Birthday: ___/___/_____ Age: ____ Nationality: _____ Native language(s) : _____. Contact Information: Student Permanent Address: _____. ADDRESS / CITY.

2 _____. STATE / PREFECTURE ZIPCODE COUNTRY. (Mobile) Phone Number:_____ Do you plan to bring your phone to the USA? Yes No Email: _____ Social Media ID/Name: _____. Such as FACEBOOK, LINE, KAKAOTALK, WECHAT, etc. Will be used mainly to keep in contact with USAI staff and will be kept confidential. Family Members: Name Relationship Age Occupation Name Relationship Age Occupation Do you have any mental / physical requirements or special needs? Yes No If yes, please explain: _____. Are you taking any medicine? Yes No If yes, please list: _____. Do you have any allergies for the categories below? If yes, please explain: Food Yes No _____ Animals Yes No _____. Medical Yes No _____ Others Yes No _____. How long do you plan to stay: in USA?_____ with Host Family?_____. Is this your first time to the USA? Yes No Previous Travel Abroad: _____. Do you have any friends or relatives living in the USA or Canada?

3 Yes No If yes, Name / Relation:_____ (_____) Email/Phone: _____. How did you hear about USA International? School Internet Agent Other _____. If applying through agent, please indicate: Agency Name: _____. Address:_____. Contact Person: _____ Phone Number: _____ Email: _____. USA INTERNATIONAL, INC. INTERNATIONAL CULTURAL & SOCIAL DEVELOPMENT. 9614 NE 201st St. Bothell, WA 98011 Tel: 425-483-5974 Fax: 425-485-1891. E-mail: / URL: Page 2. Preferences: We will use this information to do our best in finding a good student-host match. However, it is not a guarantee all of your preferences will be met. Do you prefer families with children? Yes No No preference If no, indicate range of age: _____. Do you prefer families with pets? Yes No No Preference If no, type(s) of animal: _____. Do you prefer a lot of interaction with your host family? Yes No Do you smoke?

4 Yes No Be honest! Most host families are non-smoking. If you do smoke, you will be required to smoke outside. If you cause smoke damage, you may be responsible to pay. Do you plan to buy a car in the USA? Yes No Please rate your English Level I only know a few words and the basic greetings/phrases. My English level is Beginner. I can understand if spoken slowly and clearly. My English level is Intermediate. I can understand simple conversations. My English level is Advance. I can understand complicated conversations. I can speak, write, read, and understand English fluently. Are you: Shy Independent Social Outgoing Open-minded Talkative Quiet ? How would you describe yourself? _____. What are your favorite foods? _____. What foods do you not like to eat? _____. What are your hobbies and interest? : Reading Writing Drawing Cooking Music Art Sports Movies Walking Exercise Hiking Camping Video/Computer games Others: _____.

5 What are your future goals / plans / career interest? _____. _____. Please write a letter to your host family. What can you share with your host family about you and your culture? What is your expectation or priority with the host family? (Please also include a photo of yourself and your family /pets.). _____. _____. _____. _____. _____. Feel free to attach additional page if you'd like to add more. USA INTERNATIONAL, INC. INTERNATIONAL CULTURAL & SOCIAL DEVELOPMENT. 9614 NE 201st St. Bothell, WA 98011 Tel: 425-483-5974 Fax: 425-485-1891. E-mail: / URL: Page 3. Do you need AIRPORT PICK UP service? : Yes_____ No_____. CONTACT INFO WHILE IN USA.: E-MAIL Address MOBILE Phone ARRIVAL DATE at Seattle-Tacoma International Airport: TIME OF ARRIVAL: _____:_____ AIRLINE: FLIGHT NUMBER: _____ FROM: ATTACH A PHOTO OR TELL US THE DESCRIPTION OF YOURSELF ( the color of the clothes you'll be wearing, if you wear glasses, if you have long/short hair, etc anything that helps us find you at the airport!)

6 Airport pick-up by USAI or host family is available for a service fee. See Pricing on our website for details. Arrival time must be between Monday-Sunday, 8:00 AM-8:00 PM in Pacific Standard Time USA. Airport pick-up is limited on USA Holidays and fees may be different. Flight information must be received at least 2 weeks before arrival date. You will be on our waiting list if it is less than 2 weeks. Note: The placement service fee is non-refundable, damage deposit is refundable with notice and no damage, Airport pick up service is refundable with a 7 day cancel notice. Method of Payment: PayPal (Credit Card). Personal Check / Money Order I will mail the fees to the office of USA International, Inc. Bank Wire Transfer Other - There will be an additional handling fee of $ Please note that payment must be received before application is processed.

7 HOLD HARMLESS AGREEMENT. USA International reserves the right to use its own discretion when accepting prospective students. Applications that contain erroneous or false information are subject to annulment. USA International and its agents will be held harmless from and against all claims, damages, actions, liability, and expense concerning loss of life, or personal property arising from a student participating in housing programs. Student's Signature _____ Dat


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