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Host Family questionnaire Host student: Name of the contact person (mother/father/titor): Address: Mobil phone: Telephone: E-mail: Type of accommodation: Situation: † Downtown Distance to school: † Less than 2 km

† House † Appartement † Outskirts † Between 2 km and 6 km

† More than 6 km

Number of persons in the house/appartement: Age of these persons:

Person 1: Person 2: Person 3: Person 4: Person 5:

Person Person Person Person Person

6: 7: 8: 9: 10:

Preference: † Boy † Girl † Indiferent Bedroom for the student: † Alone † Shared Meals with the student: † Breakfast † Lunch † Dinner Free time with the student: Animals: Smokers at home: † No † Yes Phobias: Religion: Languages at home: German/Spanish

English

French

Others

Speaking Writting Reading M=Mother

Reasons to participate:

Observations:

Short family description:

H=High M= Medium L=Low F=Father B=Brother S=Sister


Ficha familias