housing form

Thank you for choosing WVA to study abroad, we will provide you with best experience in Costa Rica. Please complete this form in order to provide you with the family that best match your request. You have two options to send this form to the WVA Office.

1. You can complete it using the bold key to check in the spaces of Yes or No. After completing the form you can send it back by email at info@venturesabroad.com, a message will be sent to your email account to let you know that we receive this form

Please attach one picture of you and send with the form by email

2. Mail to: You can print this form and mail it to our WVA Office at

12537 Misty Water Dr.,
Herndon, VA 20170

Personal Information
First name:		Last name:
Mailing Address:		Email address:
Phone Number:		Cell-Phone Number:
Date of Birth:	yy.
How well do you know Spanish?
Beginner		Advanced
Intermediate		Native Speaker

How long have you been taking Spanish?

Do you have experience with foreign languages other than Spanish?

Family Requirements

Describe any allergies you have.

Do you like animals? Yes No

Do you smoke? Yes No

Do you want to be the only student in your home? Yes No

Do you want to have another student hosted in the same family? If so, write the name of the student below.

Describe the family you want to live with. For example, big/small family, children/no children pets/no pets.

Are you a vegetarian? Yes No

Do you have any special dietary needs? Yes No

Describe your diet.

Check any foods that you cannot eat
Dairy
Cheese
Sea Food
Shellfish
Red Meat
Pork
Chicken
Fish
Other

Do you have any medical prescriptions, medical conditions, or other special conditions that we need to know about?

Please describe your family background?

What will be your goals for this Study Abroad Program?

Have you ever been abroad before? If so, where and how was your experience?

housing form

Personal Information

How well do you know Spanish?

Family Requirements