MyEducation Host Family Reference Form

Name

First Last

Email

You do not have to provide an email address but it will assist us to respond to your enquiry promptly

Contact number

You do not have to provide a phone number but it will assist us to respond to your enquiry promptly

Home Town/City

Date of Birth

Current Year at School

Have you ever been an exchange student before?

Yes
No

Preferred destination for exchange?

Preferred program length?

2 - 3 months
5 months
10 months

Preferred departure date?

Describe yourself briefly as a person, your interests, hobbies, school subjects and why you want to do an exchange.

Do you speak any foreign languages?

Yes
No

If yes, please list languages and years of experience

What is your average grade at school currently?

Do you have asthma or allergies? Please list your allergies

Please list any dietary requirements

Have you ever been treated for a mental or physical illness?

Yes
No

Have you discussed this application with your parents?

Yes
No

Have you discussed this application with your school?

Yes
No

Would you like to be added to our email list?

Yes
No

Please confirm by ticking the box below that you have read and understood the Privacy Notice and that you consent to the personal information described being collected and processed by My Education (UK) Limited for the reasons given.

Consent*

I have read and understood the Privacy Notice

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Host Family Reference Form

Host Family Reference Form

High School Pre-Application Form