Welcome To AEI

AEI Homestay Application

You must be an AEI Intensive Program applicant to apply for AEI Homestay.

Instructions:

This application has two parts. Please complete this first part (below) and then click the "submit" button. You can also print this first part of the application, fill it out and mail it to AEI.
After you finish Part 1, print out and sign Part 2. Part 2 will appear automatically after you submit this page, but you can also see it now: See Part 2 now.
Send Part 2 (and Part 1 if you print it), the application fee of 150 US Dollars, and a photo of yourself to:

Questions? Need help with this application form? Please email us: Web Contact Form.

Note: * = Required information.

What term do you want a homestay family?

Term:

*

**For extended deadlines contact AEI by phone (541) 346-3945, FAX (541) 346-3917, or Web Contact Form.

Contact Information

Family Name:

First Name:

Middle Name:

Present Address:

City:

State or Province:

Country:

Postal Code:

Phone number:

FAX number:

Birth date:

* Month Day Year

Birth Place:

Nationality:

Sex:

Male Female

Email Address:

Permanent Address:

City:

State or Province:

Country:

Postal Code:

Phone number:

My Family

Name	Age	Occupation	Relationship

Personal Information

Would you feel comfortable living with a family with small Children?

Yes No

Is Religion an important part of your life?

Yes No

If YES, what is your religion?

Are you a member of a club or organization?

Yes No

If YES, what clubs?

What countries have you visited?

Personal Habits

Do you smoke?

Yes No Sometimes

Do you drink alcoholic beverages?

Yes No Sometimes

Do you have specific chores to do at home?

Yes No Sometimes

If yes (or sometimes), do your chores include...

Preparing meals?	Yes No Sometimes
Cleaning the house?	Yes No Sometimes
Washing dishes?	Yes No Sometimes

Personal Health

Condition of your health:

What can you say about the condition of your health?

Do you take any medication regularly?

Yes No
If YES, why do you take medicine?

Are you allergic to any animals?

Yes No
If YES, what kind of animals?

Are you allergic to any plants?

Yes No
If YES, what kind of plants?

Are you allergic to any food?

Yes No
If YES, what kind of food?

Are you allergic to any medicine?

Yes No
If YES, what kind of medicine?

Activities: How do you spend your free time?

Reading

Often Sometimes Never

Playing Sports

Often Sometimes Never
Which sports?

Watching movies

Often Sometimes Never

Watching television

Often Sometimes Never

Listening to music

Often Sometimes Never
What kinds of music?

Playing a musical instrument

Often Sometimes Never
What kinds?

Shopping

Often Sometimes Never

Siteseeing

Often Sometimes Never

Cycling

Often Sometimes Never

Hiking

Often Sometimes Never

Talking with friends

Often Sometimes Never

Other interests and hobbies:

School

What is your English speaking ability?

Good Fair Poor Very Poor

How many years have you studied English?

Last school attended:

Major:

Present or future occupation:

Personality Information: Please describe yourself using the following information. Are you...

Adaptable

Often Sometimes Never

Independent

Often Sometimes Never

Serious

Often Sometimes Never

Shy

Often Sometimes Never

Open-Minded

Often Sometimes Never

Is there any other information that you think is important for your host family to know?

Application Fee

How would you like to pay the application fee?

Due: 150 US Dollars
(Click to change.)

Please send payment (check, international money order or credit card number) with Part 2 of the homestay application via air mail to:

American English Institute
5212 University of Oregon
Eugene, OR 97403-5212

Submit Homestay Application

Submitting Form:

Click button to submit application:

After you submit Part 1, Part 2 of the Homestay application will appear. Print out Part 2, sign it and send to AEI by air mail.

American English Institute
107 Pacific Hall
5212 University of Oregon
Eugene, OR 97403-5212, USA
Fax: (541) 346-3917, Office: (541) 346-3945
Email: aei@uoregon.edu Email Contact Form