Homestay Introduction Form | The Chinese Language Institute

Basic Information

Name *

First

Last

Date of Birth *

Email *

Program Name *

Health Declaration

Health Certificate Upload *

Click or drag a file to this area to upload.

You may have your doctor complete and sign this template showing that you are in good health and fit to live with a Chinese family, or he/she may use their own form.

Student Profile

Profession

If not applicable, enter N/A

Hobbies and Interests

Dietary Restrictions

If not applicable, enter N/A

Favorite Chinese Foods

Least Favorite Chinese Foods

Allergies

If not applicable, enter N/A

Health Restrictions

If not applicable, enter N/A

Spoken Chinese Level

Selected Value: 0

On a scale from 0 to 6, with 0 being 'Absolute Beginner' and 6 being 'Highly Advanced', how would you rate your current spoken Chinese ability?

Personal Note or Additional Comments

Any additional information you would like to share with your homestay family prior to your arrival (optional)

Your Photo

Click or drag a file to this area to upload.

Families often request a recent photo of their guest prior to your arrival. If you would like to share a recent photo of yourself, please upload one here (optional)

Participant Signature

I declare that: *

My 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).