Accommodation Request Form

Since 1984

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About IIE

    Institute of Intensive English                                                                                    ...Honolulu, Hawaii
             iiemahalo@hawaii.rr.com   Tel : 808.924.2117  Fax : 808.924.3227
               2155 Kalakaua Avenue, Suite 700  Honolulu, HI 96815, USA

Accommodation Request Form


	First Name

	Middle Name

	Last Name




			Birthdate


	Accommodation Start Date (Check-in)

	Accommodation End Date (Check-out)

					mm/dd/yyyy



		mm/dd/yyyy



		mm/dd/yyyy


	Type of Accommodation


	If you are interested in Homestay please review the application form and agreement.


	Do you smoke?


	Do you have allergies?


	If yes, please describe


	Do you take any medications?


	If yes, please describe


	What are your hobbies?


	Can you live with pets?


	If other, please describe


	Can you live in a family with children?


	If you have any questions or problems with this form, please contact us.


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