Student Application

Personal Details

Male or Female *

Name *

First

Last

Nationality *

Age *

Date of Birth *

Religion

Telephone *

Mobile

Email

Your Home Country Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Passport Number *

Emergency Contact

Full Name *

Phone *

Email

Relationship to you

Health Conditions

Do you have any allergies/medical conditions we need to know about? (if yes, please provide details below) All information supplied is confidential

Visiting Information

Please provide the full UK address including postcode of your place of study or work. This will help us find the best location for your homestay.

Booking Information

Level of English

Duration of Homestay

Arrive Homestay date *

Depart Homestay date *

How many single rooms? *

How many twin rooms? *

Accommodation Type *

Do you have any special dietry requirements, (dairy-free, gluten-free, halal, kosher, nut-free etc)? *

Yes
No

If yes, please provide further information

Are you Vegan? *

Yes
No

Are you Vegetarian? *

Yes
No

Do you have food allergies? *

Yes
No

Do you smoke? *

Yes
No

Would you be happy to be placed with a homestay host that may have the following?

Children under age 11 *

Yes
No

Cats? *

Yes
No

Dogs? *

Yes
No

Another student speaking your first language? *

Yes
No

Flight Details

Flight Number Arrival UK

Arrival Airport/Terminal UK

Arrival Date and Time

Date

Time

Do you reqiure transfer? *

Departure Date and Time

Date

Time

Do you reqiure transfer? *

If you are travelling with someone else please put their full name below

How did you hear about Stella Homestay Services? *

DATA PROTECTION STATEMENT – Stella Homestay Services respect your privacy, and the personal information supplied here is protected under the Data Protection Act. We will not disclose this information to any third parties other than to the potential host, college, university and any authorised inspectors/regulatory bodies without your prior consent. You are entitled to demand access to any information referring to you. *

I accept that I have read and agreed to the Stella Homestay Services terms and conditions and wish to proceed.

Student Application

Personal Details

Emergency Contact

Health Conditions

Visiting Information

Booking Information

Would you be happy to be placed with a homestay host that may have the following?

Flight Details

CONTACTS

+447584876729

info@stellahomestayservices.com

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