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Student Application form
Application for a stay abroad
Email address *
Family name/Surname *
Your answer
Student's first name
Your answer
Home address including city *
Your answer
Postal Code *
Your answer
Student's Date of Birth + Gender *
Your answer
Mother's name and Occupation *
Your answer
Mother's Mobile Phone Number *
Your answer
Father's Name and Occupation
Your answer
Father's Mobile Phone Number
Your answer
Student's Mobile Phone Number *
Your answer
Landline/Emergency Contact Number *
Your answer
Student's Hobbies *
Your answer
Please list any Allergies, Illnesses or Impairments *
Your answer
Names and current ages of siblings *
Your answer
What Country does student want to travel to? *
Your answer
What programme are you applying for *
Student nationality + First language *
Your answer
Preferred Travel dates *
Your answer
Is it the first time away from home alone? *
Your answer
How many hours per day does the student spend on smart phone/ computer *
Your answer
Describe the student personality *
Your answer
Food dislikes *
Your answer
Do you require airport transfers? *
Your answer
Any other relevant information
Your answer
FOR IRISH STUDENTS ONLY applying for exchange. What dates can you host an exchange student
Your answer
FOR IRISH STUDENTS ONLY applying for exchange. Will exchange student have their own bedroom
Your answer
FOR IRISH STUDENTS ONLY applying for exchange. Please specify childcare arrangements in place in your home during any times when both parents / guardians may be away / at work.
Your answer
FOR IRISH STUDENTS ONLY applying for exchange. Do you have pets? Please specify.
Your answer
FOR IRISH STUDENTS ONLY applying for exchange. Parents hobbies.
Your answer
Name of Person completing the application and relationship to the student *
Your answer
We consent to and authorise Chez Nous Homestay (CNH), its representatives or the host family, to act in our place and to sign on our behalf for any emergency procedures required in the event of an accident or other emergency and pay all expenses for any treatment or procedure undertaken. We give permission for our child to exit his/her home country . We confirm that there is no reason whatsoever that the person seeking the homestay programme is unsuitable for the programme requested. We have read and agree with the general conditions of CNH for students and exchange families. *
Required
Please note that some countries require parents/guardians to complete a consent form so their child may travel unaccompanied. *
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