Host Family (Nominated Guardian) Application Form

Title

First Name

Surname

Date of Birth

What is your marital status?

Gender

Nationality

What is your ethnic or cultural background? (optional)

Please specify your ethnic background

Religion

Mobile

Home Phone Number (optional)

Occupation

Address

Property name (if any)

House number

Room number

Street

Town/City

County

Country

Postcode

What type is your house?

How many rooms for student?

What gender of students are you happy to host?

How old are the students you are happy to host?

14 and lower 14-16 years old 16-18 years old 18 and above

Do you have any previous experience hosting international students?

Yes No

How many years of experience do you have?

What is your highest level of education?

Please specify your qualification

Are you willing to complete safeguarding children training, online safety training, homestay safeguarding training, and any other required training?

If your answer is No, you are not eligible to continue this application.

Yes No

Are you happy to provide a DBS check for yourself and for all other household members aged 16 and over who live in the same household?

If your answer is No, you are not eligible to continue this application.

Yes No

Does anyone in the household smoke?

Yes No

How many people aged 16 and over live in your household with you?

Do you have children?

Yes No

How many children do you have?

Please provide their ages:

Do you have a valid Enhanced DBS check issued within the last 3 years?

Yes No

Do you have pets?

Yes No

Are you happy to provide the following documents to support your application? Failure to submit any of them may result in the application being unsuccessful.

✓ 1. Two referees
✓ 2. Valid Enhanced DBS check with Children's Barred List certificate
✓ 3. Safeguarding Children Training certificate
✓ 4. Homestay Safeguarding Training certificate
✓ 5. Online Safety Training certificate
✓ 6. Proof of identity (driving licence, valid passport, or birth certificate)
✓ 7. Proof of address (utility bill, bank statement, GP letter, or Home Office letter issued within the last 3 months)
✓ 8. Car insurance (if applicable)
✓ 9. Home insurance
✓ 10. Completed medical declaration form
✓ 11. Completed homestay checklist by GO (Guardianship Organisation – Prima Guardian)

Your answer

Yes No

When is the most convenient time to contact you?

Please specify your preferred contact time

How did you hear about us?

Please specify

Declaration Agreement

I hereby confirm that the information provided in this application is true, complete, and accurate to the best of my knowledge and belief. I understand that any false, incomplete, or misleading information may result in the rejection of my application or termination of any homestay arrangement. I agree to comply with all policies, rules, and safeguarding requirements set by the homestay provider and acknowledge my responsibility to adhere to relevant UK regulations. I consent to the processing, storage, and use of my personal data for the purposes of assessing my application, arranging accommodation, and ongoing management of the homestay placement. Where required, I agree to background and reference checks, including DBS checks.

Sign and Submit By (Full Name)

Date

+44 7460 745729

Host Family (Nominated Guardian) Application Form

Prima Guardian :

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+44 7460 745729