Host Family Application Form

You and your family details

Applicant details

First Name (required)
Family Name (required)
Age (required)
Nationality (required)
Mother Tongue (required)
Address (required)
Post Code (required)
Telephone (required)
Mobile (required)
Work Telephone (required)
Email (required)

Partner details

First Name
Family Name
Age
Nationality
Mother Tongue

Details of children / other family members

Member 1

Name
Age
Gender
At home/not

Member 2

Name
Age
Gender
At home/not

Member 3

Name
Age
Gender
At home/not

Member 4

Name
Age
Gender
At home/not

Other details

Please give details of any domestic pets including breed of cats and dogs: (required)
Does anybody at your house smoke? (required)
Is your family vegetarian? (required)
Would you host a vegetarian? (required)
Are there any unusual family circumstances or medical problems? (required)

Your home / house details
(please tick/fill in where applicable)

TerracedSemi-detachedDetachedBungalowFlatOther

Total number of bedrooms? (required)
Do you have dining area? (required)
Do you have sitting room? (required)
Total number of bathrooms? (required)
Number of toilets? (required)
Do you have central heating? (required)

Students
(Please tick/fill in where applicable)

Room 1
SingleTwin sharedTwin aloneDouble aloneWardrobeDrawer spaceDesk/tableTV

Room 2
SingleTwin sharedTwin aloneDouble aloneWardrobeDrawer spaceDesk/tableTV

Room 3
SingleTwin sharedTwin aloneDouble aloneWardrobeDrawer spaceDesk/tableTV

Facilities available to student(s)

Do students have exclusive use of any of the bathroom, shower and toilet facilities? (required)
Regular laundry service? (required)
Provision of key? (required)
Place for private study, with chair? (required)
Access at all times to the sitting room? (required)
Telephone for incoming calls? (required)

GardenTVDVDPCWi-Fi
Half boardSelf catering

Any other facilities available for students?

Travel Information

Which bus routes can be used to travel to and from Hove Town Hall? (required)
What is the approximate journey time to the Hove Town Hall by bus? (required)
How far is your house from the nearest bus stop? (required)

Hosting Preferences

Number of students
Sex
Age
Any restrictions?

Confirmation

Please tick here if it would be acceptable to pass your details on to a third party when we are legally
obliged to do so (for example a criminal record check or accreditation bodies)? Please note that this is very
important for students’ welfare and it may affect our decision to lodge students with you. (required)

Any other information?

I confirm the details above are true. I have read and agree to the terms.

Signed (required)
Name in CAPITALS (required)
Date (required)