STUDENT PROFILE

Family name :

First(given) name :

Address :

Zip code :

Telephone :                 E mail :                           Fax :

Birthdate(    /      /     )    Male(     ) Female(     )

Interests/Activities/Hobbies.





List Some Activities you'd like to participate in while in canada.






Do you have any food Allergies/Preferences?




Do you have any other Allergies of Health problem?




Would you prefer a home with children.        (       )       
                        without children.     (       )

If with, state age preference.
(e.g. young children, teenagers)




Would you prefer a home with Pets          (       )                              
                            No Pets        (       )
                            Dogs only      (       )                           
                            Cats only      (       )    


Do you Smoke?      Yes(      )            No(       )

How long do you plan to study in canada?



What is your English Ability Level?
                       Excellent      Good        Fair       Poor             
Speaking               (      )     (      )    (      )   (       )
Writing                (      )     (      )    (      )   (       )
Understanding          (      )     (      )    (      )   (       )

Why did you choose to come to calgary?





Name, Address & Telephone of person to contact in an Emergency?
(e.g. parents address, relative address)





Additional comments or information.