SIL Sapporo Nihongo Gakko

Homestay Application

As I start my homestay I agree to the following conditions:

to promptly compensate the host family for any damaged items;
to do all my own cleaning and washing;
to help out in the homestay family's house;
not to make phone calls using the homestay family's phone;
not to use the homestay family's computer;
to discuss curfew, phone rules, garbage rules and any other rules on my first day, and observe them;
to let the mother know if I will not be having dinner with the family or if I will be late for dinner;
to let SIL know if I have any problems regarding food or other matters;
I understand that the homestay is for the benefit of my Japanese learning. I will stay with the host family only while I take the intensive course at SIL.

I would like to apply for homestay during:

Notes:

cf.Courses page

Name:

male female

Date of Birth:

Nationality:

Current Mailing Address (Include street, city, postal code, and country):

Phone Number:

Fax Number:

E-mail Address:

Present School or Job Status (Include name of company or university and year):

Educational Background (Name of last school attended and date of graduation):

What are your interests and hobbies?

Favorite sporting activities:

Would you be comfortable in a home that permits smoking?
Yes No

Do you smoke?
Yes No

Would you be comfortable in a home that has pets?
Yes No

Please list any allergies (food, medicine, animals ...)

Please list any dietary restrictions you may have:

Please describe any specific health problems you may have:

In the event of an emergency, please provide us with your parent's (or other) names, address, and phone number:

Arrival date and time:
Departure date and time:

Please tell your Japanese host about your character, personality, and anything else they should know about you:

Please be sure to click the submit button once after filling in the form and send the appropriate application fee and a photo to SIL.
If you have trouble emailing this application, print it out and mail to SIL with your application fee.

SIL Sapporo Nihongo Gakko
Director & Instructor Ms. Harumi Shima
Bell Idaimae 1F, 291 Nishi 18 chome Minami 2 jo Chuo ku
Sapporo JAPAN 060-0062 Tel/Fax: 81-011-614-1101
E-mail: info@silnihongo.com