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Homestay Application Form

Please complete the application form if you wish to become a host and offer a temporary home to St Brelade’s College international students. We will contact you shortly to arrange to visit you at home.

Once you have submitted this form, please download, complete and post back to us one social service check form per member of your family aged 18 years or above and one personal reference form per family. Once you have submitted your application, you will find these forms on the following page.

* Indicates required fields

Your details

Your full name: *

Full home address: * *

Postcode: *

Home telephone number: **

Work telephone number: *

Mobile telephone number: *

Email address: *

Date of birth: *

Religion: *

Nationality: * *

Your occupation: **

Place of work: **

Spouse's full name: *

Spouse's date of birth: *

Spouse's occupation: *

Spouse's place of work: *

Spouse's religion: *

Spouse's nationality: *

Your children

Name

Date of birth

Male/Female

Living at home?

Other occupants

Name

Date of birth

Male/Female

Occupation

Relationship

PLEASE NOTE THAT CHILDREN OR OTHER OCCUPANTS AGED 18 OR OVER LIVING IN YOUR FAMILY HOME WILL ALSO BE SUBJECT TO BACKGROUND CHECKS. PLEASE ALSO INCLUDE THEM ON A SEPERATE SOCIAL SERVICE CONSENT FORM ENCLOSED. ADDITONAL FORMS CAN BE POSTED ON REQUEST OR DOWNLOADED ON WWW.JERSEYHOMESTAY.CO.UK

You & your home

Your family interests & activities (eg sports, BBQ, beach visits) *

Do you have any pets? *

Yes

Outside only

Are you smokers? *

Yes

Are you vegetarian? *

Yes

Which internet access do you have at your home? *

Type of dwelling? *

Student bedrooms available? (room 1) *

Student bedrooms available? (room 2)

Ensuite / Own bathroom? *

Yes

Study area provided? *

Yes

Who would you prefer to host? *

	10-12 yrs		13-18 yrs		Adults		Anyage
	Male		Female		Either gender

When would you like to host students? *

	Summer only
	Easter to October
	All year (If you live on the South Coast for transport reasons)

Your confirmed holiday dates:
(If dates are not confirmed, please inform the accommodation officer with plenty of notice)

From:

To:

From:

To:

From:

To:

Is there anything else that you think we should know about your circumstances?

How did you hear about us? *

I/We agree to abide by the English Uk Code Of Practice for providers of homestay accommodation for International students: *
To encourage the student to speak English as much as possible in our home
To encourage the student to feel at home and to treat him/her as a member of the family rather than a paying guest
Not to host another student of the same native language at the same time unless by special arrangement with St Brelade’s College
To provide a clean and comfortable student room
To provide a home environment in which it is possible for the student to carry on his/her English studies
To provide the student with a balanced and appropriate diet To show concern for the welfare, safety and security of the student during his/her stay
To give the student reasonable and regular access to bathroom and laundry facilities
To maintain a close liaison with St Brelade’s College and so be in a position to help resolve any problems that the student may encounter during his/her stay
To respect the student’s cultural background and be sensitive to the needs of the student

I/We agree to abide by the homestay duties & guidelines outlined in St Brelade’s College Homestay Handbook

I/We agree to work exclusively with St Brelade’s College

I CONFIRM THAT NONE OF THE OCCUPANTS OF MY HOUSE HAS, OR HAS EVER HAD, A POLICE RECORD THAT WOULD RENDER ME/US UNFIT TO HOST STUDENTS AND HAVE NEVER HAD A CHILD REMOVED FROM OUR CARE. *

REFERENCES AND BACKGROUND CHECKS

It is essential that we screen potential host families on behalf of the children’s families who live overseas, for the children we represent and for the general good of everyone involved in hosting children. You can be assured that all information collected and given will be treated in the strictest confidence. These checks consist of you consenting for St Brelade’s College to contact Social Services to gain a reference (complete Social services check form enclosed –separate form for each member of household 18 years or over) & you providing a character reference (complete personal reference check form enclosed – one reference per family). Your character referee can be a close friend, neighbour, employer or a professional who will support your application as a suitable host family that is able to provide suitable accommodation and supervision to an overseas student.

Homestay Application Form

Language School UK