student information 
  have you ever been an international student before? *  
 - select - yes no 
  student number *  
 
  sur / family name *  
 
  given / first name *  
 
  age *  
 
  gender *  
 - select - male female other (if you have chosen this option, please specify) 
  marital status *  
 - select - single married 
  e-mail address *  
 
 
student questionaire 
  do you have any allergies? *  
 - select - yes no 
  please describe allergies:  
 
 
  is there a specific food plan you follow? for example, are you vegetarian or vegan? do you not eat pork or beef? *  
 - select - yes no 
  are you comfortable in a pet friendly home? *  
 - select - yes no 
  do you follow any specific religious practices at home that you'd like to share? *  
 - select - yes no 
  would you be comfortable living in a home that observed religious traditions? *  
 - select - yes no 
  would you prefer:  *  
 - select - with meals ($900.00/month) without meals ($675.00/month) 
  why are you interested in taking part in the homestay program? what do you hope to learn or gain from this program? *  
 
 
  what foods do you enjoy and dislike? additionally, please mention any food allergies you have.  
 
 
  how long are you planning to study at 阿根廷vs墨西哥竞猜
, english language centre? *  
 
 
  do you have any challenges with movement or getting around that you are okay with telling us? *  
 - select - yes no 
  if yes, please describe below: *  
 
  do you have health concerns you are comfortable telling us? *  
 - select - yes no 
  if yes, please describe below: *