Application for Homestay
Click for information on How to Apply
Please answer all required fields (marked with *) then press "Submit Application" button.
First Name: *
Last Name: *
Where did you hear about us?
Please explain,
Gender: *
Nationality: *
Level of English Competency: Low    Medium    High
Date of Birth: // (month/day/year) *
Telephone: Country-Area-Number *
Fax: Country-Area-Number
E-mail: *
Permanent Address: Street: *
City: *
State or Province:  
Postal/Zip Code:
Country: *
Check-in Date:
// * (Month/Day/Year) IMPORTANT:
     * We encourage you to Check in and check out on a Saturday or Sunday. There is a $50 surcharge for weekday arrivals.
Check-out Date:
// * (Month/Day/Year)      * Check out must be at least 1 week after check in.
Flight Information: Arrival Date:                      //                Time:   
Airport:    Flight Airline and #:  
Purpose of Visit: Educational    Internship      Other
what school or business:   *
Do you smoke? *
Are pets ok in the home? *
Are children ok in the home? *
Do you have any food, pet or other allergies?: *
If yes, please explain:
Will you have a car?: *
Do you have an international drivers license?: *
Is there anything else
you would like us to know?:
Accommodation Preferences:
Prices per week. Bed and Breakfast
(with continental breakfast)
Full Homestay
(with continental breakfast & dinner)
Economy (shared room, shared bath) $250.00 $285.00
Standard (private room, shared bath) $300.00 $345.00 (Most Popular)
Executive (private room, private bath) $375.00 $430.00
* These prices are based on our standard rates and do not include any special discounts.
* Executive pricing may vary +/- 10% depending on the actual accommodations.
* There is a premium of $100/week for stays of 2 weeks or less.
* There is a 12% premium on the first 2 weeks of stay if booked less than 4 weeks in advance.
* There is a $50 premium for weekday arrivals.

A placement fee is required for us to process your application.
The standard placement fee, excluding any applicable discount, is: $250

View our complete Payment & Refund Policy
Offer Code: What is an Offer Code?
Means of payment for placement fee: VISA    Master Card    Wire (additional fees may apply)
Card Number: *      Prefer to fax your credit card information?
Expiration Date: /   (MM / YY) *
"I understand by submitting this application my credit card will be charged the non refundable placement fee if a suitable host is found for me"
Experiencing difficulties with your application? Contact us at

Home | What is Homestay | Types & Prices | Online Application
Special Offers | Log-in | Useful Links | Agents | Hosts | Japanese Web Site