Host Family Application Form

Applicant Details

Name*

First Last

Age*

Nationality*

Mother Tongue*

A photo of yourself

Address*

Street Address Address Line 2 Town County / State / Region Postal Code Country

Home Phone

Mobile*

Work Telephone

Email*

Details of Children / Other Family Members

Do you live with a partner?*

Yes
No

Do any other family members live with you? If so, how many?*

Partners Details

Name*

First Last

Age*

Nationality*

Mother Tongue*

Household Member 1

Name*

First Last

Age*

Gender*

Living at home*

Household Member 2

Name

First Last

Age*

Gender*

Living at home*

Household Member 3

Name*

First Last

Age*

Gender*

Living at home*

Household Member 4

Name*

First Last

Age*

Gender*

Living at home*

Other Details

Please give details of any domestic pets including breed of cats and dogs

Does anybody at your home smoke?*

Are there any unusual family circumstances or medical problems?

Your home / House details

What type of house do you live in?*

Total number of bedrooms?*

Do you have a dining area?*

Yes
No

Do you have a sitting room / lounge?*

Yes
No

Total number of bathrooms?*

Number of toilets?*

Do you have central heating?*

Yes
No

Photos of your house

Drop files here or

Please try to include a picture of the front of your house if possible

Students

How many rooms do you have available to students?*

Room One*

Single
Twin Shared
Twin Alone
Double Alone
TV
En-suite bathroom

please select all that apply

Room Two*

Single
Twin Shared
Twin Alone
Double Alone
TV
En-suite bathroom

please select all that apply

Room Three*

Single
Twin Shared
Twin Alone
Double Alone
TV
En-suite bathroom

please select all that apply

A photo of the student/s bedroom

Drop files here or

Facilities available to student(s)

Do students have exclusive use of any of the bathroom, shower and toilet facilities?*

Yes
No

Place for private study, with chair?*

Yes
No

Access at all times to the sitting room / lounge*

Yes
No

Other facilities available to students?*

Any other facilities available for students?

Catering and Food Options

Please select all of the options below that you are happy to provide.

Food and catering options you are happy to provide?*

Self Catering (Room Only) - Set Times for Kitchen Use (Adult Students only)
Standard Package - (Bed - Breakfast - Dinner and 2 Packed Lunch) - Any extras at additional cost
Special Diet Requirement - Halal Food
Special Diet Requirement - Vegetarian
Special Diet Requirement - Vegan
Special Diet Requirement - Gluten Free
Late check in and check out
Packed lunch - Monday to Friday

Travel Information

Which bus routes can be used to travel to and from Canterbury City Centre?*

What is the approximate journey time to Canterbury City Centre?*

How far is your house from the nearest bus stop?*

Hosting Preferences

Number of Students you are willing to host?*

Sex*

Age Preference*

Under 18
18 and Over

Do you drive and are you happy to collect and drop off under 18 students from their arrival and departure points.*

Yes
No

Any restrictions?

Confirmation & Consents

Consent*

Please tick here to confirm it is 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.

Terms & Conditions*

I agree to the Homestay Provider Terms & Conditions

Any other information?

CAPTCHA

Signed*

Name in CAPITALS*

Date*

Comments

This field is for validation purposes and should be left unchanged.

Host Family Application Form

Applicant Details

Details of Children / Other Family Members

Partners Details

Household Member 1

Household Member 2

Household Member 3

Household Member 4

Other Details

Your home / House details

Students

Facilities available to student(s)

Catering and Food Options

Travel Information

Hosting Preferences

Confirmation & Consents

Do you have questions? Do you need more information?

How’s Your English?

Students

Agents

Homestay Hosts

Terms & Policies