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2 Application Form:
Personal
and Health
Information.
Your answer to any of these questions will not eliminate you as a candidate. However, special consideration may be required with regards to host family.
* 表示必填問題
電子郵件
*
提交回覆時記錄我的電子郵件地址
Your best e-mail:
*
We will contact you by your mailing address.
您的回答
Your full name:
*
您的回答
Name you wish to be called:
您的回答
What was your assigned sex at birth?
*
選擇
Male
Female
Intersex
Prefer not to say
What are your preferred pronouns?
*
He/Him/His
She/Her/Hers
Prefer not to say
其他：
What is your gender identity?
*
Male
Female
Non-binary
Transgender Male
Transgender Female
Genderqueer
Genderfluid
Two-Spirit
Prefer not to say
其他：
Do you and your family have any to consider regarding the sexual orientation and gender identity of the student?
*
Yes
No
其他：
Are you married and living with the person?
*
Yes
No
其他：
If yes to the question above, Is the person agreeable to hosting a student?
*
Yes
No
其他：
How many people live with you?
*
Please, use the space below to
describe your relationship
with them. Are they your relatives/family members? Friends? Or do you live alone?
您的回答
Are the people living with you aware of and in agreement with hosting a student?
*
Yes
No
其他：
List your house pets, if you have any:
*
您的回答
What is the work schedule of family members?
*
您的回答
Does your family have any rules or restrictions regarding the time the student should be home? Please explain.
*
您的回答
Will the student have access to a house key during the exchange month?
*
Yes
No
其他：
What are your and your family’s hobbies and interests?
*
您的回答
What is your Religion?
*
您的回答
Do you have any special requirements regarding religious observance? Please detail:
*
您的回答
Do you accept that the student hosted with you has a different religion from yours and/or your family members?
*
Yes
No
其他：
Do you smoke or use tobacco products?
*
Yes
No
Does any family member smoke?
*
Yes
No
其他：
Do you allow smoking in your home?
*
Yes
No
Do you drink alcohol?
*
Yes
No
What are your family’s rules about the drinking of alcohol?
*
您的回答
Have you ever used illegal drugs?
*
Yes
No
What are your feelings about the legal or medicinal use of cannabis products?
*
您的回答
If yes to the question above, please explain.
*
Otherwise
just write "
it does not apply
"
您的回答
Do you have any dietary restrictions, follow any specific diet or food options and/or allergies (e.g. vegetarian, vegan, nut, gluten, lactose, etc.)? If yes, please explain.
*
您的回答
Are you comfortable hosting people with different eating habits (e.g. vegans, carnivores, ketogenic, etc.)?
*
Yes
No
Do you have any current mental health/medical/dental conditions?
*
Yes
No
Have you been treated for mental health/medical conditions in the past two years?
*
Yes
No
Have you taken any prescribed medications in the past six months?
*
Yes
No
Do you have any special health requirements (disabilities)?
*
Yes
No
If you have answered ‘YES’ to any of the above please explain fully in the space below providing as much information as possible, including the name and any medication and the reason prescribed.
*
Otherwise
just write "
it does not apply
"
您的回答
Will you consent to a Criminal Record check of all adults living in the home?
*
Yes
No
Write anything else that you feel is important for student(s) to know about your household (food, laundry, family rules, etc)
*
您的回答
Commitment of Honour and Truth:
*
I declare under commitment of honour that all the information provided is true and legitimate, being aware that I will respond judicially for false information or in disagreement with reality.
必填
Before proceeding, please access and read the SOUL BILINGUE PRIVACY AND DATA PROTECTION POLICY.
*
English version
Portuguese version
I agree with the Soul Bilingue Privacy Policy
That is it! Are you ready?
After submitting this form, we will contact you!
Please keep an eye on your mailbox.
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