Family Name:

First Name:

Street Address:

Suburb:

Area Code:

Email:

Phone (home):

Phone (work):

Phone (mobile):

Mother:

Father:

Child:

Child:

Child:

Does anybody in your house smoke?:

Do you allow students to smoke in your house?:

Do you have computer / Internet facilities for student use?:

Can students use wireless internet in your house?:

Is your home::

How many bedrooms?:

How many bathrooms?:

How many toilets?:

How many room(s) can you provide for student(s):

To what ethnic group to you belong to?:

Is English the language used at home?:

If no, what language is?:

Do you have any religious affiliation?:

Have you hosted international students before?:

Are you currently on the hosting list other institutions?:

If yes, please list the schools you currently host for:

Please lists any animals that you have and indicate if they are indoor or outdoor pets?:

Do you have any food preferences?:

Does anybody in your house play a musical instrument? Please detail:

How far from your house is the nearest bus stop? What number bus would students use?:

How many minutes from your home to the city centre? (please indicate if walking or by bus):

Smokers:

Couples:

Vegetarian:

Diabetic:

Gender Preferred:

Under 16:

16-18:

18-19:

Over 20:

All ages:

IEI will send students’ their host family profile before they arrive in New Zealand. Please write a paragraph or two telling us about your home features and family environment, your family members and their hobbies and interests, which will help students to get a picture of where and who they will be living with. The students may contact their host family to introduce themselves before they arrive.:

We will create a family profile to send to students from this information, and would like to include a family/home photo. Can you please upload a recent photo of your family and/or home. Maximum 2 photos, no more than 1MB each.:

Name:

Date: