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Apply To Be a Host Family with ELI Schools
1.
Main Applicant Details (Primary Host Contact)
Full Name
Home Address:
Date of birth:
Mobile Number:
Home phone:
Email:
Occupation:
Interests:
2.
Second Host Contact - (partner, spouse or other adult)
Full Name
Date of birth:
Relationship to host:
Mobile Number:
Occupation:
Interests:
3.
Child 1 (Skip if does not apply)
First Name:
Date of Birth:
Male or Female:
4.
Child 2 (Skip if it does not apply)
First Name:
Date of Birth:
Male or Female:
5.
Child 3 (Skip if does not apply)
First Name:
Date of Birth:
Male or Female:
6.
Child 4 (Skip if does not apply)
First Name:
Date of Birth:
Male or Female:
7.
Other Adults Living in the Home (Family or Otherwise)
Full Name
Relationship to host:
Gender:
Age or Date of birth:
Occupation:
What rooms do you have available in your home?
Bedroom 1
8.
Bedroom 1 - How many beds in the room?
Single Bed
Twin Beds (2 Singles)
Triple Beds (3 singles)
Double bed
9.
Bedroom 1 - Is it private ensuite bathroom access or shared bathroom?
Private ensuite
Shared bathroom access
Bedroom 2
10.
Bedroom 2 - How many beds in the room?
Single Bed
Twin Beds (2 Singles)
Triple Beds (3 singles)
Double bed
11.
Bedroom 1 - Is it private ensuite bathroom access or shared bathroom?
Private ensuite
Shared bathroom access
Your Home
12.
Do you have WIFI Internet in your home the student can use?
Yes
No
13.
Do you have pets living in your house?
No
If Yes please give details:
14.
Does anyone in the home smoke inside the house?
Yes
No
15.
Do you allow students to smoke inside the house?
Yes
No
16.
Routine:
Is there any adult in the home during the day?
Yes
If Not, when does the first person arrive home?
17.
Meals:
Please indicate which meals you can provide if requested?
Vegetarian
Vegan
Coeliac
Allergy/Peanut
18.
Access:
Is your home suitable for disabled or students with limited ability?
No
If Yes, please give details
What type of students would you prefer? - we can't guarantee but will give options
19.
What age of students would you prefer?
Groups (age 12-17) - minimum 2 per time
Adults (aged 18+) - mainly placed as individuals
Either (no preference)
20.
What gender would you prefer?
Male Only
Female Only
Either (no preference)
Getting to ELI Schools - the daily commute for students
21.
What is the best form of transport to ELI Schools from your house?
22.
How long does the journey take?
Legal Declaration & Data Protection
23.
I have read and agree to the ELI Schools Host family guidelines
Yes
No
24.
Have you or any family member been convicted of a criminal offense?
Yes
No
25.
Have you or any family member had a child removed by order of the courts?
Yes
No
26.
I understand that Garda Vetting is a requirement and agree to complete the process with ELI Schools
Yes
No
27.
I understand that Garda Vetting is a requirement and agree to complete the process with ELI Schools
Yes
No
28.
I authorise ELI Schools to use my personal contact information for the purpose of contacting me regarding hosting international students and to supply this information to students booked to stay in my home:
Yes
No
