HOST TEACHER APPLICATION PERSONAL DETAILS Your full name:   Your address:   Town / city:   Postcode:   Country:   Home phone number: Mobile phone number: Fax number: E-mail address: Tutor's first name:   Date of birth:   Qualifications:   If currently working, please give details:   Language teaching experience: (please give details including dates, position and school/organisation)   Other work experience: (please give details including dates, position and school/organisation)   Indicate any areas of specialist teaching ability e.g. business, medicine   Active hobbies and interests including sports:   Foreign language(s) spoken and approximate level(s):   Spouse's fist name:   Date of birth:   Qualifications:   If currently working, please give details:   Language teaching experience: (please give details including dates, position and school/organisation)   Other work experience: (please give details including dates, position and school/organisation)   Indicate any areas of specialist teaching ability e.g. business, medicine   Active hobbies and interests including sports:   Foreign language(s) spoken and approximate level(s):   Will more than one member of the family be teaching:   please choose: yes no If yes, please confirm who:   Qualifications:   Has this already been discussed with our local organiser:   please choose: yes no Specify number and type of pets:         YOUR FAMILY AND OTHERS LIVING AT HOME Person 1 First name: Relationship: Date of birth: Job / studies: Active interests / sports: Family situation: please choose: adult child normally at home all the time child normally at home only during academic holidays son or daughter no longer at home Person 2 First name: Relationship: Date of birth: Job / studies: Active interests / sports: Family situation: please choose: adult child normally at home all the time child normally at home only during academic holidays son or daughter no longer at home Person 3 First name: Relationship: Date of birth: Job / studies: Active interests / sports: Family situation: please choose: adult child normally at home all the time child normally at home only during academic holidays son or daughter no longer at home Person 4 First name: Relationship: Date of birth: Job / studies: Active interests / sports: Family situation: please choose: adult child normally at home all the time child normally at home only during academic holidays son or daughter no longer at home Person 5 First name: Relationship: Date of birth: Job / studies: Active interests / sports: Family situation: please choose: adult child normally at home all the time child normally at home only during academic holidays son or daughter no longer at home       YOUR HOME Kind of home:   please choose: flat detached house semi-detached house terraced house Location:   please choose: seaside village seaside town seaside city inland village inland town inland city If village, indicate nearest large town and distance in kilometres (km) or miles (m):   Public transport and regularity:   number of bedrooms: 1 2 3 4 5 6 7 8 number of bathrooms / shower-rooms 1 2 3 4 number of WCs 1 2 3 4 Do you have: car computer garden   piano parking private bathroom/shower-room (for student's sole use) STUDENT ROOM(S) Room 1 type of room: single twin double basin table lamp chest of drawers mirror Dimensions: wardrobe central heating table/desk and chair   Room 2 type of room: single twin double basin table lamp chest of drawers mirror Dimensions: wardrobe central heating table/desk and chair   LOCAL AMENITIES tennis not available walking distance short distance by bus/train by car golf not available walking distance short distance by bus/train by car water sports not available walking distance short distance by bus/train by car swimming not available walking distance short distance by bus/train by car horse-riding not available walking distance short distance by bus/train by car shops not available walking distance short distance by bus/train by car sports centre not available walking distance short distance by bus/train by car theatre not available walking distance short distance by bus/train by car   cinema not available walking distance short distance by bus/train by car library not available walking distance short distance by bus/train by car   TRAVEL Nearest international airport: Distance in miles (m) or kilometres (k): Nearest port: Distance in miles (m) or kilometres (k): Nearest railway station: Distance in miles (m) or kilometres (k): Directions from nearest international airport by public transport:   STUDENT PROFILE Does anyone in your family smoke:   please choose: yes no Are you willing to accept smoking in the whole house:   please choose: yes no Are you willing to accept smoking in designated rooms:   please choose: yes no Which:   Are you willing to accept smoking outside:   please choose: yes no Are you willing to prepare special diets e.g. vegetarian:   please choose: yes no Maximum hours tuition per week you wish to teach:   please choose: 15 hours 20 hours 25 hours 30 hours Age group preferred:   please choose: up to and including 15 16 - 18 19 - 24 25+ I don't mind Sex preferred:   please choose: male female accept both

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