Bell Accommodation Services > Your Information

Thank you for your interest in our program.

We require fully furnished private apartments or shared accommodation (including all linens and kitchen equipment), available on a monthly basis. Our clients are very independent ESL students, English speaking students or business people. They do their own shopping and cooking.

Please note: In a shared situation, we do not require you to be home weekends and evenings. This is not a Homestay, you are free to come and go as you please.

1.	Name: Occupation: Spouse: Occupation:
2.	Address: City: Postal Code: Closest main intersection: Tel Home: Work: Email: Fax # Home: Office: Pager/Cell:
3.	Pets:
4.	Smoking household: Yes No Will you accept someone who smokes outside: Yes No
5.	Please indicate whether your accommodation is: Part of your living space. E.g. private bedroom(s), shared kitchen, bathroom, and TV room Completely separate. E.g. apartment or suite, with own front door Part of your living space but with private bedroom(s), own kitchen, bathroom, and TV room. E.g. shared entrance, separate floor.
6.	How many people do you usually accommodate at one time:
7.	How many bedrooms/bathrooms do you have for client use: Bedrooms: Bathrooms:
8.	A) Do you have any religious beliefs/practices you would like the client to be aware of: B) Who will be the primary contact person with the emergency number: Name: Number:
9.	Travel time to downtown by public transport: Minutes: Bus Number:
10.	Number of blocks from your home to nearest bus stop/sky train station:
11.	How many buses would the client need to take to get downtown:
12.	Is there a time of year when your accommodation would be unavailable: Yes No From: To:
13.	Would you be willing to undergo a criminal record search: Yes No
14.	References: (neighbours, employers, family Doctors, teachers):

Fill out the following questions (15-19) in a shared situation only.

15.	In a shared accommodation, please provide name, year of birth and gender of any children living at home:
16.	Is anyone else living in your home (e.g. Grandparents, boarder, or roommate):
17.	Do you have preferences as to the client's gender in a shared situation: Gender:
18.	Which languages are used at home:
19.	In a shared situation, have you accommodated people before: Yes No A) With which organization(s): B) May we contact these organizations for a reference: Yes No

20.	Please feel free to include any additional comments:

CONTACT US: email: info@bellacc.com | phone: 604-875-1742 | fax: 604-875-1752