Homestay Provider Application Form

Personal Details

First Name:

Family Name:

Address:

City:

Postcode:

Email:

Date of Birth:

Home Telephone:

Mobile:

Work Telephone:

Fax Number:

Occupation:

Religion:

Household Members

Please list any other persons living in your home:

Name:

Relationship:

Date of Birth:

Occupation:


Name:

Relationship:

Date of Birth:

Occupation:


Name:

Relationship:

Date of Birth:

Occupation:


Name:

Relationship:

Date of Birth:

Occupation:

Household Information

What language do you speak at home?

Are any other languages spoken at home? Please list them:

Description of house/accommodation: (e.g. 3 bedroomed semi-detached bungalow)

What are your family's interests and hobbies?

How many rooms do you have available for student accommodation? (e.g. 1 medium single room and 1 large room with two beds)

What facilities do you have near your home? (e.g. Sports Centres, etc.)


Does anyone in the house smoke?

Do you have a working smoke alarm?

Will the student have a bedroom of his/her own?

Is the student's room ensuite?

Do you have internet access for the students to use?

Do you have any pets?

If yes, how many and what type?

Students

Which of the following are you willing to accommodate?

Females 18+

Males 18+

Students

Will you accept students who smoke/vape? (NB outside only)

Are you willing to accommodate long-term students (6 months or more)?

Are you willing to accommodate short-stay students (3 – 10 days)?

Will you provide the student with a house key?

Could the student prepare their own food?

Can you cater for special dietary needs? If so, which:

Vegetarian?

Halal?

Food Intolerances/Allergies?

Are you willing to carry out a Fire Risk Assessment on your home?

Are you willing to obtain a Gas Safety Certificate?

Are you willing to show proof of ID?

Are you willing for ILS to take up references?

Transport

What number bus route would the students use to get to the city centre?

What bus company is used to get to the city? (NCT, Trent Barton, Other)

Additional Information

Any further information or preferences that might help us to place the right student in your home?

I have received and read the Homestay Guidelines.