Host Family Application Form
Thank you for your interest in being a host family for EIL UK.
EIL UK is a charity, which is part of a global Federation across 23 countries. We run a series
of programmes each year, which aim to bring people together to create a more peaceful and
understanding world and we do this by providing homestays for our international visitors. We aim to
develop a hosting community, which shares our values and beliefs. In turn our host families have the
opportunity to immerse themselves in this global network, take part in our international programmes
and ‘bring the world to their door’.
Please fill in this form so that we can find out more about you and match you with the most suitable
visitors. The more info you can give us, the better matches we can make. Please contact EIL UK if you have
any questions.
1a About host parent one (primary contact)
Surname: ………………………………………………….………….
First name: ……………………………………………………………
Known As/Preferred Name: …………….…………….……
Address: ……………………………………………………………………………………………………………………………………….….……….…..
…………………………………………………………………...…………… Postcode: ……………………………………………………………..
Date of Birth: …………………………………….…….……………..
Nationality: …………………………………………………..…..…
Home Tel Number: …………………………………….…………… Home Fax Number: …………………………………..………...
Mobile Number: ……………………………………………..........
Email: ……………………….…………………………………….….…
Occupation: (if retired add pre-retirement occupation) ……………………………………………………………………….………
Company: …………………………………………………..
Nature of Business: …………………………...…………………..
Full/Part Time: …………………………………………..
Work pattern if appropriate: ………………………………………
Work contact details will only be used in the event of an emergency when other contact methods have failed
Work Telephone Number: ………………………………….………Work email………………………………………………………………
Religion: ……………………………………………………..
Do you practise: regularly / occasionally / rarely / N/A ?
Do you smoke? Yes / No
If yes: inside house / only outside
Languages spoken …………………………………….. basic / can get by / fluent
Languages spoken …………………………………….. basic / can get by / fluent
Interests: ………………………………………………………………………………………………….……………………………………...………..…
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HF Form 03/14
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1b About host parent two
Surname: .………………………………………………….………….
First name: ……………………………………………………………
Known As/Preferred Name: …………….…………….….…
Address: ……………………………………………………………………………………………………………………………………….….……….…..
…………………………………………………………………...…………… Postcode: ……………………………………………………………..
Date of Birth: …………………………………….…….……………..
Nationality: …………………………………………………..…..…
Home Tel Number: …………………………………….…………… Home Fax Number: …………………………………..………...
Mobile Number: ……………………………………………..........
Email: ……………………….…………………………………….….…
Occupation (if retired add pre-retirement occupation) ………………………………………………………………………….………
Company: …………………………………………………………
Nature of Business: …………………………...…………………...
Full/Part Time: …………………………………………………
Work pattern if appropriate: ………………………………………..
Work contact details will only be used in the event of an emergency when other contact methods have failed
Work Telephone Number: ………………………………….… Work email ………………………………………………………………
Religion: ………………………………………………………… Do you practise: regularly / occasionally / rarely / N/A ?
Do you smoke? Yes / No
If yes: inside house / only outside
Languages spoken ……………………………………….. basic / can get by / fluent
Languages spoken ……………………………………….. basic / can get by / fluent
Interests: ………………………………………………………………………………………………….……………………………………...………..…
…………………………………………………………………………………………………………………………………………………………………….…
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HF Form 07/14
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1c Additional adult living in the home
EIL UK seeks details relating to any further adults, over the age of 18, who reside in the family home, these
may be grown up children, lodgers or other international visitors who will stay in your home for longer than
two weeks.
Surname: ………………………………………………….………….
First name: ……………………………………………………………
Known As/Preferred Name: …………….…………….……
Address: ……………………………………………………………………………………………………………………………………….….……….…..
…………………………………………………………………...…………… Postcode: ……………………………………………………………..
Date of Birth: …………………………………….…….……………..
Nationality: …………………………………………………..…..…
Home Tel Number: …………………………………….…………… Home Fax Number: …………………………………..………...
Mobile Number: ……………………………………………..........
Email: ……………………….…………………………………….….…
Occupation (if retired add pre-retirement occupation) ………………………………………………………………………….………
Company: …………………………………………………..
Nature of Business: …………………………...…………………..
Full/Part Time: …………………………………………..
Work pattern if appropriate: ………………………………………
Work contact details will only be used in the event of an emergency when other contact methods have failed
Work Telephone Number: ………………………………….………Work email………………………………………………………………
Religion: ……………………………………………………..
Do you practise: regularly / occasionally / rarely / N/A ?
Do you smoke? Yes / No
If yes: inside house / only outside
Languages spoken …………………………………….. basic / can get by / fluent
Languages spoken …………………………………….. basic / can get by / fluent
Interests: ………………………………………………………………………………………………….……………………………………...………..…
………………………………………………………………………………………………………………………………………………………………………
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HF Form 07/14
Page 3 of 9
1d Additional adult living in the home
Surname: ………………………………………………….………….
First name: ……………………………………………………………
Known As/Preferred Name: …………….…………….…….
Address: ……………………………………………………………………………………………………………………………………….….……….…..
…………………………………………………………………...…………… Postcode: ……………………………………………………………..
Date of Birth: …………………………………….…….……………..
Nationality: …………………………………………………..…..…
Home Tel Number: …………………………………….…………… Home Fax Number: …………………………………..………...
Mobile Number: ……………………………………………..........
Email: ……………………….…………………………………….….…
Occupation (if retired add pre-retirement occupation) ………………………………………………………………………….………
Company: …………………………………………………..
Nature of Business: …………………………...…………………..
Full/Part Time: …………………………………………..
Work pattern if appropriate: ………………………………………
Work contact details will only be used in the event of an emergency when other contact methods have failed
Work Telephone Number: ………………………………….………Work email………………………………………………………………
Religion: ……………………………………………………..
Do you practise: regularly / occasionally / rarely / N/A ?
Do you smoke? Yes / No
If yes: inside house / only outside
Languages spoken …………………………………….. basic / can get by / fluent
Languages spoken …………………………………….. basic / can get by / fluent
Interests: ………………………………………………………………………………………………….……………………………………...………..…
………………………………………………………………………………………………………………………………………………………………………
………………………………………………………………………………………………………………………………………………………………………
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IF OTHER ADULTS LIVE IN YOUR HOME PLEASE CONTINUE ON A SEPARATE SHEET
1e Your Children – please give details of all children who are under 18 or living away from home
Child’s Name
Date of Birth
At Home /Away
Hobbies
m/f
m/f
m/f
m/f
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2. Your Home
Please describe your home (Circle the most appropriate)
Flat
terraced house semi-detached
detached
Number of bedrooms ……………… Number of bathrooms …………… Do you have a garden? Yes / No
Location of your home: City / Town / Village / Farm / Rural (please circle)
Do you have any pets? Dogs ……………. Cats ……………… Others…………………………………………………………..….......
If yes, do they live inside the house or outside? ……………………………………………………….……………….…………………
How many rooms are available exclusively for hosting?
Double …….…. Single …….…. Twin ……….. Other ………
When hosting EIL UK visitors the expectation is that they will have a room for their own use, which offers
privacy. Long-term visitors must also have a dedicated study space provided in their room.
Will the visitor have internet access in your home?
Yes, via family computer / Yes, via WIFI using their own laptop or phone / No
If No, how far is the nearest location for free internet access? ………………………………………………………………..…
3. Transport
Do you have a family car?
Yes / No
Do you live close to a bus route? Yes / No
Distance to nearest school with Sixth Form……………..… Time by public transport to school …………………….
What is your nearest train station? …………………………………….……………….. How far is it? ….…………………..….
Are you willing to ensure that your international visitor can safely travel to planned educational or cultural
events either by driving them or via public transport?
Yes / No
4. Lifestyle
Which adjectives would best describe your home lifestyle (tick all that apply):
close knit outgoing formal shy socially active sophisticated reserved religious musical
artistic strict sporty very busy hardworking down to earth lenient communicative flexible
liberal conservative traditional quiet
How often do you eat together around the table as a family?
What activities would you like to do together?
Can you suggest any local activities your visitor might enjoy?
Do you have a piano (tuned!) in your home or other musical instruments? Yes / No
HF Form 07/14
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5. Your Visitor
EIL UK runs programmes throughout the year and visitors can stay for between one day and an academic
year.
Are you able to host visitors who will stay for (please circle):
One day / Weekend / 1 - 4 weeks / 4 - 12 months / All
Are you able to host:
Males only / Females only / Either
Under 18 / Adult / Either
Single visitor / double placement / family (adults plus their children)
Can you host someone with any of the following dietary requirements?
Vegetarian
/
Vegan
/
Kosher
/
Halal
/
Lactose Free
/
Wheat Free
(Please also indicate if any member of your family follows any of these diets)
……………………………………………………………………………………………………………………………………………………………………..
Can you host a smoker? Yes / No
Do you host for another organisation? Yes / No
If yes, please specify ..……………………………………………....…
Occasionally it is necessary to find an emergency placement for a visitor at short notice. These tend to work
best when the host family are able to support the visitor fully in the day, so most suitable for those who do
not currently work full-time.
Are you interested in joining the EIL UK emergency placement list? Yes / No
If yes, EIL UK will make contact with you to discuss and support.
6. Hosting
EIL UK is a charity committed to developing world peace and better understanding between people.
Please explain your reasons for wanting to host:
Do you have any experience of hosting?
Does your family enjoy travel and learning about other cultures?
Have you ever stayed with a host family in another country? What did you learn from the experience?
For longer stay hosting, what kind of personality would fit in with your family?
Would you like to receive further details about EIL UK’s homestay abroad opportunities? We can offer
homestays with our global partners to exciting locations such as Japan, Mexico and Albania.
Is there any other information you feel you should share with EIL UK about your family or your home?
Please attach photographs of family members, your home and the visitors bedroom/s.
HF Form 07/14
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7. Safeguarding
EIL UK is committed to safeguarding and promoting the welfare of children, young people and vulnerable
adults and expects all host families to share this commitment. EIL UK has a responsibility to ascertain the
suitability of potential host families. In accordance with this, EIL UK will:
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ask you to complete and sign this application form
ask all adults in your home to apply for an enhanced Disclosure and Barring Service check
undertake a home visit
take up references
store your information on our secure database for the period you are a host family with EIL
offer training and support
The CRB (criminal records bureau check) has now changed and is called a DBS (Disclosure and Barring
Service) check. You may have undertaken a DBS check already, in which case EIL UK needs to see the
original copy of this (please see next page for details). If you have not, an EIL UK representative can talk you
through the process and help you to complete the form.
I hold a current (please circle)
Adult 1, name:
certificate number:
issue date:
CRB form (undertaken within the last three years) / DBS form / neither
Adult 2, name:
certificate number:
issue date:
CRB form (undertaken within the last three years) / DBS form / neither
Adult 3, name:
certificate number:
issue date:
CRB form (undertaken within the last three years) / DBS form / neither
Adult 4, name:
certificate number:
issue date:
CRB form (undertaken within the last three years) / DBS form / neither
If yes, please include a photocopy for each with this application. It is a requirement that your local
representative sees the original form for each adult at the host family address.
Please confirm that your EIL local representative has seen the original CRB or DBS form for each adult
Yes /No
Are you happy for us to carry out annual Status Checks to ensure that all DBS remains valid? Yes / No
The amendments to the Exceptions Order 1975 (2013) provide that certain spent convictions and cautions
are ‘protected’ and are not subject to disclosure to employers and cannot be taken into account. Guidance
and criteria on the filtering of these cautions and convictions can be found at the Disclosure and Barring
website www.gov.uk/DBS
HF Form 07/14
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8. Declaration
All adults aged 18 years or over, permanently or regularly resident in the home, must read and complete
the sections below (please use another sheet for additional adults)
Address of Host Family: …………………………………………………………………..……………………………………………………………
Adult 1 Full Name: ……………………………………………………………………………………..………………………………………..………
Have you ever been accused of any offence?
Yes / No
Have you ever had a child removed from your care by a court order?
Yes / No
Signed: ………………………………………………………….……………….
Date: …………………………………………………………..
Adult 2 Full Name: …………………………………………………………………………………………………………………….…..……….……
Have you ever been accused of any offence?
Yes / No
Have you ever had a child removed from your care by a court order?
Yes / No
Signed: …………………………………………………………………………….
Date: ……………………………….………………………..
Adult 3 Full Name: ……………………………………………………………………………………..………………………………………..………
Have you ever been accused of any offence?
Yes / No
Have you ever had a child removed from your care by a court order?
Yes / No
Signed: ………………………………………………………….………………...
Date: ………………………………………………………..
Adult 4 Full Name: ……………………………………………………………………………………..………………………………………..………
Have you ever been accused of any offence?
Yes / No
Have you ever had a child removed from your care by a court order?
Yes / No
Signed: ………………………………………………………….……………….
Date: …………………………………………………………..
If you have answered ‘yes’ to any of these questions, please supply details on a separate piece of paper
addressed to Victoria Perry, Chief Executive, EIL UK, 17 Graham Road, Malvern, Worcestershire, WR14 2HR
Information provided will not necessarily affect your suitability as a host family.
9. Reference
Please give the details of two independent referees (not a family member) who have known all
signatories on this form for at least two years.
Referee 1
Name: ……………………………………………………………. Relationship to family: ..…………………..………………..……...……..
Address: ……………………………………………………………………………………………………………………...…………….…………….……
Telephone number: ………………………………….…… Email: ………………….……………………….……………….……………..……
Referee 2
Name: …………………………………………………………… Relationship to family: ..…….…………………………..……...………..
Address: ……………………………………………………………………………………………………………………...…………….…………….……
Telephone number: ……………………………….….…. Email: ……………………….……………….……………….…………….….……
HF Form 07/14
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10. Confirmation
I have seen and read the EIL UK Host Family Information Pack and I agree to abide by the
attached code of conduct of EIL UK.
I understand that EIL UK has the right at any time to refuse my offer of hosting for whatever
reason.
I have answered all of the above questions on this form truthfully and there is no reason why I
should not be considered a suitable person to act as a member of a host family.
Adult 1 Full Name: …………………………………………………………………………………………………………………….…..……….……
Signed: …………………………………………………………………………….
Date: ……………………………….………………………..
Adult 2 Full Name: …………………………………………………………………………………………………………………….…..……….……
Signed: …………………………………………………………………………….
Date: ……………………………….………………………..
Adult 3 Full Name: …………………………………………………………………………………………………………………….…..……….……
Signed: …………………………………………………………………………….
Date: ……………………………….………………………..
Adult 4 Full Name: …………………………………………………………………………………………………………………….…..……….……
Signed: …………………………………………………………………………….
Date: ……………………………….………………………..
Please return to:
EIL UK, 17 Graham Road, Malvern, Worcestershire, WR14 2HR
01684 562577
info@eiluk.org
www.eiluk.org
HF Form 07/14
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