CAIS Homestay Form | The Chinese Language Institute

Basic Information

Name

First

Last

Chinese name in 汉字

Chinese name in pīnyīn

Date of Birth

Gender

Male
Female
Non-binary
Other

Gender:

Preferred gender identity of homestay buddy

Male
Female

Email

Program

Student Profile

How to you describe yourself?

Check at many as apply

Other:

Tell us about your favorite activities and interests

Consider sports, musical instruments, favorite subjects in school, hobbies, things you are involved in outside of school, etc

Please tell us about your parent(s), including their names and occupations

Do your parents speak any Chinese (Mandarin or other dialects)?

Do you have siblings? If so, please tell us their names and ages

What do you like to do together as a family?

Consider weekends, evenings, mornings

What are some of your favorite foods (especially Chinese-style foods)?

What foods do you particularly dislike?

Is it ok if the host family has pets?

Yes, any and all pets are ok
Yes, some pets are ok (please explain below)
No, pets are not ok (please explain below)
Other

Yes, some pets are ok:

Please explain here

No, pets are not ok:

Please explain here

Other:

Please explain here

What modes of transportation do you most commonly use in San Francisco?

Driving with parents / family members
Public transportation
Walking
Other

Other:

Have you previously traveled to Taiwan or mainland China?

Yes
No

Have you ever spent more than a few days away from your family?

Is there anything else you want your host family to know about you or your family?

CAIS Roommate Preference

You will have the opportunity to share accommodations with fellow CAIS students at various times during our travels. Please list your preferred CAIS roommates below.

Roommate preference #1

First

Last

Roommate preference #2

First

Last

Roommate preference #3

First

Last

Roommate preference #4

First

Last

Parent Section: Dietary and Health Information

This section is to be completed by parents. Allergy, dietary and medical information will also be shared with the host family so they know how to care for your child.

Does your child have any food allergies or dietary restrictions?

If none, please write "none"

Additional dietary comments

Please use the above space to provide any additional information about your child's dietary needs and preferences that you think might be helpful to your program organizers or homestay family.

Does your child have any drug allergies?

If none, please write "none"

Any other known allergies?

If none, please write "none"

Is your child currently taking any prescription medications?

If none, please write "none"

Please describe any medical conditions, physical restrictions, disabilities, or special considerations:

Please describe any emotional / behavioral / mental health considerations:

Select any of the below conditions that your child has experienced in the past three years:

Name of your child's Primary Care Physician

If none, please write "none"

Phone Number of your child's Primary Care Physician

If none, please write "none"

Email of Primary Care Physician

If none, please write "none"

Any additional health information that the host family should be aware of?

Is there anything about your student's gender, sex, or family structure that you would like us to know? If you prefer to share this information directly, please contact Julie Farrell (j_farrell@cais.org). CAIS considers this private and confidential information that will only be shared with your expressed permission and guidance.

Parent Section: Contact Information

This section is to be completed by parents. Please note that your contact information will be shared with the host family.

Best ways for the host family and/or CAIS chaperones to communicate with you

We strongly encourage pre-trip communication between families! WeChat (link opens in new tab) is a very popular messaging, voice and video chat app in Guilin. Please note here your preferred email addresses, Skype names, etc.

Parent's Email

Parent's cell number for FaceTime

Parent's WeChat ID

Parent/Guardian Signature

I declare that:

My child's information as entered above is accurate and correct to the best of my knowledge.
I have read and I accept CLI's Homestay Waiver (link opens in new tab).

Homestay Introduction Form

Basic Information

Student Profile

CAIS Roommate Preference

Parent Section: Dietary and Health Information

Parent Section: Contact Information

Parent/Guardian Signature