Host family application form

Please provide as much information as possible as this will help us to match you with the most suitable host families and to make your homestay experience as pleasant as possible. Please note that any question with * next to it is a mandatory question. Please put 'NA' for any mandatory questions that do not apply to you.

Please have all information to hand as it is not possible to save this form

About you and your household

Host's Name*

Partner's Name (if applicable)


House Number and Street Name*


Postal/Zip code*

Host's main phone number*

Host's alternative phone number

Host's Email Address*

Partner's Email Address

Host's Occupation*

Partner's Occupation

Host's age range
 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65-74 years old 75 years or older

Partner's age range
 18-24 years old 25-34 years old 35-44 years old 45-54 years old 55-64 years old 65-74 years old 75 years or older

Names and ages of children (if applicable)

Is English the main language spoken in your home?*
 Yes No

Please provide details of any other languages spoken in your home?*

Approx. what time do you normally eat dinner in the evening?*

Any pets in your house? Please give details*

Does anyone in your household smoke?*
 Yes No

If so, where do they smoke?

Would you accept a smoking student provided they smoke outside?*
 Yes No

What are you family's hobbies and interests?

About your home

Type of Property*
 House - detached House - semi-detached House - terrace Flat

How long have you lived at the property?*

What is the fastest means of getting to the town centre*

How long does it take (in minutes) to get into town via this means of travel?*

Frequency of buses or trains into town*

Are the buses or trains direct?*
 Yes No

Number of bedrooms available to let to students

Type of room (room 1)*

Type of room (room 2)

Type of room (room 3)

Number of bathrooms*

Number of Toilets*

Living room*
 Yes No

Separate dining room*
 Yes No

Do you have a valid Gas Appliance Safety Certificate?*
 Yes No

Do you have household insurance to cover a paying guest?*
 Yes No

Do you have the following in your home:

 Yes No

Internet access student can use*
 Yes No

Full Central Heating*
 Yes No

Continuous hot water*
 Yes No

 Yes No

Please provide the name and address of your GP*

Your preferences with regards to the students

Are you prepared to welcome:

Mature students (over the age of 30)*
 Yes No

Long stay students (longer than 3 months)*
 Yes No

Will you accept students throughout the year*
 Yes No

If no to the above question, when would you accept students?*

Additional Information

How did you hear about us?

If you were introduced by a friend, please give their name

From when are you available to host students?

Please confirm that you are happy for us to share the information provided in this form with any student once we have secured them a place in your home

Please confirm if you would be happy to publicise any pictures or details about your home on our web site or other marketing material

 Yes No

Please provide any additional information you think is relevant

***Thank you - Your application is complete***

Data Protection Statement
The information which you give when completing your application form will be used in accordance with the Data Protection Act 1998 and for the following purposes: to enable the organisation to create an electronic and paper record of your application; to enable the application to be processed; to enable the organisation to compile statistics, or to assist other organisations to do so, provided that no statistical information that would identify you as an individual will be published. The information will be kept securely, and will be kept no longer than necessary and at all times in accordance with our Data Protection Policy, which can be provided upon request.

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