HKIS 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

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?

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 information regarding your child that the host family should be aware of?

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.

Parent's Email *

Parent's LINE ID *

LINE (link opens in new tab) is a very popular messaging, voice and video chat app in Taiwan. We encourage all parents to download LINE for ease of communication during the program.

Parent's cell number

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 (HKIS)

Basic Information

Student Profile

Parent Section: Dietary and Health Information

Parent Section: Contact Information

Parent/Guardian Signature