Study abroad in China--Learn Chinese language with homestay

Study Chinese with Homestay

ATTENTION: Before completing this form, please read Homestay Payment Procedure and Refund Policy carefully and thoroughly.

Personal Information
(All information will be kept confidential. For more info see our privacy policy)

* First name

* Last name

* Street Address

* City

State in the U.S.

State or region outside of the U.S.

* Country

Zip code

* Phone number
Country code	area code	prefix	suffix
cell number
Country code	area code	prefix	suffix

* Email address

* confirm email address

* Gender

* Date of birth

* Place of Birth

Passport #

* Passport valid until

* Nationality (citizenship)

Religion

* Emergency contact person

* Relationship

* Phone number
Country code	area code	prefix	suffix

Name of school or university currently attending

Employment History:(Job Title, Employer, Dates of Employment, etc.)

*Please indicate your Chinese language level:

Languages you can speak:

Homestay Information
(For detailed info about our host families, see Host Family and FAQ)

* Where would you prefer to do a homestay ?(Please indicate name of the university you are going to attend).

* Please select your desired price range

* Arrival date

* Length of Stay

* Do you smoke? Yes No

* Do you mind a family with a preschool-age child ? Yes No

* Do you mind a family with pets? Yes No

* Are you interested and qualified to apply for our Free Homestay Package?(Please note: a $50/week administration fee is required to apply for free homestay)
Yes No

* If a free homestay is not available, would you still be willing to join our program?
Yes No

Please indicate a few of your hobbies or special interests. We will try to match these with a host family

Please list any allergies, health problems, or foods that you can not eat.

Use the space provided below for any additional detail about yourself.

* How did you hear about Lotus?
Please specify

TERMS AND CONDITIONS

By initialing below, I agree that I have read the program information, understand and accept the conditions under which these programs will be conducted, particularly those which apply to the homestay fee and refund policy. I understand that the program cost includes administrative expenses, and hereby release Lotus, their agents, employees or representatives from all actions suits, claims, or liability for damages arising out of my participation in the program. I confirm that I have also read the "Notice of Understanding Between Participant and Lotus"

Please type initial here

Before submitting the registration form, please print it out for your record. If you can't make on-line submission, please fax the printed form to us at 408-884-2429.