Virtual Homestay Request Form Question Title * 1. Last and First Name Question Title * 2. Date of Birth (month/day/year) Date of Birth Date Question Title * 3. Where do you live? (City/Town and Country) Question Title * 4. Email Address Question Title * 5. Native Language Question Title * 6. English Level (Advanced Beginner minimum required to participate) Advanced Beginner Intermediate Upper Intermediate Advanced Question Title * 7. Tell us about your Personality Question Title * 8. Tell us about your Hobbies Question Title * 9. Tell us about your Family and Pets Question Title * 10. Have you visited the U.S.? Yes No If yes, where have you visited and when? Question Title * 11. Which device will you be using for virtual homestay session? Laptop or Desktop Computer Tablet Smartphone (iPhone) Smartphone (Android) Other (please specify) Question Title * 12. Please tell us which type of online communication platforms(s) you use. Choose all that apply. Skype Google Meet/Google Hangouts WhatsApp Facetime Zoom Other (please specify) Question Title * 13. How many weeks are you interested in a Virtual Homestay Experience? Choice of one or two sessions per week maximum. $45 per session. One week Two weeks Three weeks Four weeks More than four weeks Other (please specify) Question Title * 14. Which date(s) and time(s) - (in your time zone) are you interested in your first Virtual Homestay Experience session? Please choose at least one date and time. Date / Time Date Time AM/PM - AM PM Date/Time Date Time AM/PM - AM PM Date/Time Date Time AM/PM - AM PM Date/Time Date Time AM/PM - AM PM Question Title * 15. Do you have any comments or questions? Done
