Edinburgh Institute
STUDENT HOMESTAY APPLICATION FORM |
| → What is your full name? |
| → Do you have an English Name? |
→ What is your age? ______years
→ Date of birth: |
□Male □Female |
→ How many weeks do you wish to stay?
→ From _______________ |
_________ weeks
To: ____________________ |
| → Do you smoke? |
□Yes □No |
| → Are you a vegetarian? |
□Yes □No |
| → Is there any food you cannot eat? |
No / Yes – please specify: |
| → Do you like pets? (Cats, dogs etc) |
□Yes I like:___________________________
□No I don't like_______________________ |
→ Are you allergic to: Any medicines
Any foods
Any insect bites
Other allergies
|
No / Yes______________________________
No / Yes______________________________
No / Yes______________________________
No / Yes______________________________ |
| → Do you have to take any kind of medicine? |
No / Yes
If yes please state: _____________________ |
| → Do you drink alcohol? |
▲Yes ▲No |
| → Do you speak any English? |
▲None
□A little
□Fluent |
→ What are your hobbies? _______________________________________________________
______________________________________________________________________________ |
→ Any other information you would like to include: ______________________________________
______________________________________________________________________________ |
| → Signature: Date: |
