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Personal Details
First Name
Last Name
Age
 
Nationality
Mother Tongue
Gender
 
City
Country
 
Home Phone
E-mail
   

Level:

Course:

Year:

Month:

Date:


Number of weeks:

Accommodation chosen
     
Host family      
Shared flat with other students      

Private flat

     
No accommodation needed

 

     
If you prefer host family:
Do you like pets?
Yes No
Do you smoke?
Yes No
Would you like to stay with a single person?
Yes No
Would you like to stay with a couple without kids?
Yes No
Would you like to stay with a couple with kids?
Yes No

Information for airport pick-up (free of charge):
Do you need an Airport Transfer on arrival?
Yes No

City of departure

Date

Time of arrival
 
Airline Company
Flight Number