Travel Request Form - MLI Homestay

Student Name *

First

Last

Student Email *

Student Cell Phone Number *

Will There be Any Other CISS MLI Students Joining The Trip? If Yes, Please List: *

Student Country of Origin *

Canadian Province You Live In *

Canadian Community You Live In *

Please Select Your Student's Coordinator *

Name of Host Family Primary Contact (First and last name) *

First

Last

Email Address of Host Family Primary Contact *

Date of Departure *

Approximate Time of Departure *

Return Date *

Approximate Time of Return *

Will The Student Miss Any Class? *

If Yes, How Many Days Will The Student Miss? *

If Yes, has the school approved your absence? *

Yes
No

Please Provide The Full Name (First and Last) of The Supervising Adult *

First

Last

Please Provide The Phone Number of The Supervising Adult Listed Above. *

Where Are You Travelling To (City)? *

How Will You Get There (Drive, Train, Bus). Please Provide The Exact Details in The Trip Details Area: *

Trip Details 1) Who will be going with you (first and last names) *

Trip Details 2) What are your plans (itinerary) *

Trip Details 3) Bus, Train or plane details and any other important details including flight numbers (departing and arriving) *

Trip Details 4) Travel plans to airport and back to homestay *

Accommodation Type: *

Address of Accommodations *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Is there any cost associated with this trip that the student will be responsible for? If so, please state the amount and what it is covering. If no, please enter "No" below *. *

Host/Student Form

PLEASE NOTE

Submissions made after 12:00PM EST will not be processed until next business day.

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