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Main Applicant Information

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People living in your home

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# Name Relationship Birthday Gender Occupation
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Tell us about your family

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Diet Information

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House Information and Student Preference

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Additional Information

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Homestay Resident Suitability Declaration

All accredited institutions of Languages Canada (LC) are committed to providing their students a secure and safe environment in homestay.

To comply with Languages Canada standards, institutions that wish to place students in homestay must require Criminal Record Checks (CRC's) from all individuals normally resident in the home who have reached the age of majority.

This declaration does not replace the CRC, except as an interim measure. For those members who wish to place students in homestay prior to the required CRC documents being received by the institution, this form must be used, and it must be received by the homestay coordinator at the LC institution before any students are placed in the home. For institutions that require CRC's to be received prior to placement, this form is not required.

Have any of your family members in your household:

1. Been convicted of any offence against a minor?

2. Had a minor removed from your care by order of a court?

3. Been disqualified from acting as a foster parent?

4. Been proven negligent while supervising minors under 18 years of age on activities/courses?

5. Would you agree to a Criminal Record Check?

Terms and Conditions:

1. I will not engage in any sexual conduct with the student or sexually harass or use my position of authority as an adult with the student in an inappropriate manner.

2. I agree that if I am convicted of an offence I shall report it within 24 hours to the LC institution or to the homestay placement agency under contract with the LC institution.

3. I hereby declare that the foregoing information is true and complete to my knowledge. I understand that a false statement may disqualify me from providing homestay accommodation.

4. I agree to apply for a Criminal Record Check (CRC) from the appropriate authorities within seven (7) days of completing this Suitability Declaration; Alternatively, Cypress will accept copies of any CRC from families who already host to any institution accredited by Languages Canada.