UNO-Costa Rica Housing Form

This program is a home stay program. Please complete the following information which will be sent to the on site coordinator. The housing coordinator will do his or her best to place our students with families that best match their mutual needs.


Student Information

Full Name:   Age:

Gender: Birthplace:  


Date of Birth(mm/dd/yy):       

Current Address Line 1:

Current Address Line 2:

City:

State:

Zip Code:

Telephone Number:  

 E-mail:    

Emergency Contact Information

Please provide the following information about a person to be notified in case of an emergency.

Full Name:  

Telephone Number:  

 E-mail:  

Current Address Line 1:

Current Address Line 2:

City:

State:

Zip Code:

Relationship:

 


Personal Information

Please answer the following short questions. Provide comments if necessary.

Do you smoke?


Do you drink alcohol?:

Do you like pets?:

Do you like to be around small children?:

Is religion an important part of your life?:

Do you speak Spanish? If so, how well?:

Do you have any special needs?:

Do you have any hobbies?:

Have you ever traveled abroad before? Please specify where:

Do you have any special dietary needs or preferences? (i.e. vegetarian):

Do you have any allergies?:

Some students may be housed together with the same family (maximum of 2 per family). Do you have a preference? If applicable, please state the name of your desired roommate:

Do you have any other information that you think is important for the host family to know?:


Clicking the "Submit Form" button acts as your signature and indicates that you have read and completed the information above to your best knowledge.



Click below to send the form: