Student Form

Payer*

Account
Student
Other

Please fill out this field.

Payer Name*

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Payer Address

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Payer Email

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First Name(s) (in entirety as shown in passport)*

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Last Name(s) (in entirety as shown in passport)*

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Student gender*

Female

Male

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Date of Birth*

Please fill out this field.

I would like custodianship

Nationality*

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Phone Number

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Student Email*

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Name of school the student will be attending (including the campus name)*
Ex: Mayflower College

Please fill out this field.

Start Date*

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Day Count

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End Date*

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Board Type*

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Private Bathroom(Additional charges will apply)*

Yes
No

Please fill out this field.

Ok with cats*

Yes
No

Please fill out this field.

Ok with dogs*

Yes
No

Please fill out this field.

Do you have any of the listed dietary restrictions?

Vegetarian
Vegan
Celiac
Lactose intolerance

Please fill out this field.

Medical Condition (requires custodian to help visit a physician regularly)

Yes, I have a medical condition

If you have any special requests such as dietary restrictions and/or if you have any allergies, please indicate here.
Also if you are going to share the same room with another student and/or if you want to be placed in the same house with another student,
please indicate that student's full name here:

I'd like to be picked up at the airport*

Yes
No

Please fill out this field.

Please enter information for the arrival flight below*

I don't know the flight info yet

Airline Company

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Flight Number

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Arrival Time

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I'd like to be dropped off at the airport*

Yes
No

Please fill out this field.

Please enter information for the departure flight below*

I don't know the flight info yet

Airline Company

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Flight Number

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Departure Time

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Please send to us by email at admin@canbehome.ca: your passport copy, letter of acceptance from your Canadian educational institution, visa+study permit (if available), and any other documents you might want to share.

Registering a student on this portal does not guarantee a placement unless a placement is made by us. Please do not make any payments before you receive an invoice from us.

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Student Form

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