00447707155736

Student 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

Name*

Date of Birth*

Nationality*

Your Email*

Telephone*

Alternative Telephone

PERMANENT HOME ADDRESS

House Number and Street Name*

City*

Postal/Zip code*

Country*

Gender*

Smoking*

Course Enrolment

Please select from the drop down the level that most closely describes your level of English*

Type of course required*

Number of weeks of study*


Accommodation

Please describe your accommodation preferences
 Host Family Homestay Language School residences

If you selected Language School Residence, please move to the next section 'Additional Information'


Type of room preferred: Please rank in order of preference or select 'No Preference' or 'Don't Want'

SINGLE WITH SHARED BATHROOM
 1 2 3 4 5 No Preference Don't Want

SINGLE WITH PRIVATE BATHROOM
 1 2 3 4 5 No Preference Don't Want

DOUBLE WITH SHARED BATHROOM
 1 2 3 4 5 No Preference Don't Want

DOUBLE WITH PRIVATE BATHROOM
 1 2 3 4 5 No Preference Don't Want

TWIN ROOM
 1 2 3 4 5 No Preference Don't Want

We will do our best to accommodate your requirements although cannot guarantee we will provide you with your first choice

Please provide details of any food allergies or dietary preferences, e.g. vegan, vegetarian

Are you happy to live in a house with pet animals?
 Yes No

Please provide details of any allergies or phobias (which may or may not be related to animals)

Type of household preferred (Please rank in order of preference leaving blank if it is not a preference)

Family with children
 1 2 3

Male & female without children
 1 2 3

Single person of the same sex
 1 2 3

Would you be happy to share a household with a family with children under the age(s) of 2?
 No Yes

We will do our best to place you with the most suitable host family in accordance with your preferences although cannot guarantee we will provide your first choice

Medical Information:

Are you currently taking any prescription medicine?*

If Yes, please provide details

Do you suffer from asthma, diabetes, tuberculosis or any other medical condition that the host family should know about?*

If Yes, please provide details

Please provide details of any other medical conditions or information we should know about you*

Do you have any mobility problems?*
 No Yes

If Yes, please provide details

Additional Information

Would you be interested in going on any organized tours to other cities during your stay?*

Please provide any additional information about you which you think we should know about

Please upload the photo page of your passport here [max filesize: 2MB]*

Please upload a proof of address here*

***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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