California Coast Language Academy HOMESTAY APPLICATION (Please include a $100 application fee for the homestay (non-refundable) - please attach) * REQUIRED FIELDS *Student Name        *E-Mail        Address        Phone        Nationality        Date Of Birth     DD 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 MM 1 2 3 4 5 6 7 8 9 10 11 12 YYYY 1900 1901 1902 1903 1904 1905 1906 1907 1908 1909 1910 1911 1912 1913 1914 1915 1916 1917 1918 1919 1920 1921 1922 1923 1924 1925 1926 1927 1928 1929 1930 1931 1932 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000    Gender     Male        Female    Occupation or major in school        Future profession        English ability     Very High        High        Fair        Low    Would you like to be picked up at the airport?     Yes        No    Do you prefer a family with children?     Yes        No        No Preference    If yes, what age group do you prefer?     Young Children        Teenagers    Do you smoke?     Yes        No      (Please note that San Luis Obispo is a no smoking community and you will probably be asked to smoke outside if you want to smoke.) Do you like animals?     Yes        No    Do you have any health conditions?     Yes        No    If yes, please specify        Are there any foods that you cannot eat?     Yes        No    If yes, please explain        List your interests and hobbies, sports, etc.        What are your expectations of an American host family?        Do you plan on renting or buying a car during your stay in San Luis Obispo?     Yes        No    Please write about yourself        Please note: Homestays range from $600 to $700 (including breakfast and dinner). Naturally, the lower costing homestays are with families living in smaller homes. The more expensive homestays often allow the student to have their own bathroom and access to extra facilities. For more information on California Coast Language Academy 672 Higuera Street , Suite 300 · San Luis Obispo, California 93401 · USA Tel: (805) 541-8060 · Fax: (805) 547-1792 Send your comments or questions to study@cclausa.com