Student App-1

STUDENT HOMESTAY APPLICATION-1:

* After you submit the Application-1, go to next page Application-2 to complete for submission online!
NOTE: Please DO NOT SKIP any lines as it will not be submitted automatically online!!!

Fieldset

First Name *First Name
Last Name *Last Name
Email Address *
Phone *
Cell Phone
Address
Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Comments
Gender
What Country are you from? *
How old are you? *
Date of Birth *
When do you want to start your Homestay?
How long or estimated time of stay with the Hosting Family?
Name of School will be Attending? Internship?

Verification

Please enter any two digits with no spaces (Example: 12) *
This box is for spam protection - please leave it blank:

STUDENT INTERNATIONAL HOUSING, INC.

* NOTE: If you did not get a response or if you think the application did not go through please email: Ythomestay2000@yahoo.co.jp to get an alternate application!

We apologize for the inconvenience! We are looking forward to talking with you soon!