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Host Application

Assist international students to learn about British culture and practise their English.

Host Application

Male or Female *

Name *

First

Last

Age *

Occupation *

Email *

Emergency Contact Full Name *

Nearest Bus stop/number to City Centre

Approximate travel distance to City Centre

Person 1 - Full Name

Age

Male or Female

Person 2 - Full Name

Age

Male or Female

Person 3 - Full Name

Age

Male or Female

Person 4 - Full Name

Age

Male or Female

Person 5 - Full Name

Age

Male or Female

Person 6 - Full Name

Age

Male or Female

Is English The Main Language Spoken in the Home *

Yes
No

Please state any other launguage spoken in the home

Please state if you have any pets in the home *

Yes
No

What is your ethinc origin? *

What is your family religion *

State any other organisation you Host with

Property Type *

Is Your Property *

How many bedrooms? *

How many bathrooms? *

How many toilets? *

Living Area/Lounge *

Dining Room *

Other Rooms

Single Room *

Twin Room *

Ensuite/Own Bathroom *

Yes
No

Chair *

Yes
No

Desk/Table *

Yes
No

Desk lamp *

Yes
No

Wardrobe/Cupboard *

Yes
No

Chest of Draws *

Yes
No

Full Length Mirror *

Yes
No

Heating *

Yes
No

Television *

Yes
No

Room with a window *

Yes
No

Television *

Yes
No

WiFi *

Yes
No

Central Heating *

Yes
No

Hot Water *

Yes
No

Shower *

Yes
No

Access to garden *

Yes
No

Male *

Yes
No

Female *

Yes
No

Age 18 - 34 *

Yes
No

Age 35 + *

Yes
No

Which of the following Services Would you like to provide? *

Special Diets - Vegetarian, Vegan, Halal, Kosher, Gluten-free, Nut-free, Non-dairy Please specify

Use of Kitchen for Self-Catering *

Yes
No

Use of Landline for Incoming Calls Only *

Yes
No

Use of Landline Emergency Only *

Yes
No

Do Any Members of Your House Smoke? *

Yes
No

Can a Student Smoke Inside Your House? *

Yes
No

Can a Student Smoke Outside Your House? i.e garden *

Yes
No

Do you have a Gas Safety certificate? *

Service Agreement with a Gas Safe registered Engineer? *

Yes
No

Do you have insurance to cover a paying guest? *

Yes
No

Do you have working smoke alarms? *

Yes
No

Do you have a first aid kit at home? *

Yes
No

Have you done a fire risk assessment? *

Yes
No

Have you been DBS checked in the last three years? *

Yes
No

DBS Issue No:

Is any member of your household dependent on any illegal drugs? *

Yes
No

Has any member of your household been prosecuted for possession and/or misuse of Class A, B, or C drugs? *

Yes
No

Has any member of your household been prosecuted for theft? *

Yes
No

Do you or anyone in your household have a medical condition we need to be made aware of? (This is only relevant if you feel it may impact your ability to host students)

What are your family's interests and hobbies? (The information provided, may be sent to our prospective students)

Please tell us why you would enjoy hosting a student(s) in your home

How did you hear about Stella Homestay Services? *

The student(s) will be given a front door key *

Yes
No

You will offer a well-balanced diet and avoid ready meals *

Yes
No

The student(s) will be able to take a bath/shower at least once a day *

Yes
No

You will provide laundry facilities once a week *

Yes
No

The student(s) will have access to ironing facilities *

Yes
No

The student(s) will be provided with clean bed linen once a week *

Yes
No

Do you give your consent for us to use these photos? *

Yes
No

CONTACTS



+447584876729



info@stellahomestayservices.com

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