host family application form - The Bournemouth & Poole College

DO YOU HOST STUDENTS FROM OTHERINSTITUTIONS AGED 18 +?ARE YOU PREPARED TO ACCOMMODATE ASTUDENT WITH A DISABILITY OR SPECIALNEEDS.IS YOUR HOME SUITABLE FOR A STUDENTWITH A PHYSICAL DISABILITY?YOUR ACCOMMODATIONIS YOUR HOME: A FLAT TERRACEDHOUSESEMIDETACHEDHOUSEDETACHEDHOUSEBUNGALOWOTHERARE THE ROOMS YOU WILLBE USING FOR STUDENTS:SINGLE (please state how many)TWIN (please state how many)DO YOU HAVE A GASSUPPLY TO YOURPROPERTY?DO THE STUDENTBEDROOMS CONTAIN:WILL THE STUDENTS HAVEACCESS TO THE INTERNETWHEN AT YOUR HOME?IS THERE ANYTHING ELSEYOU WOULD LIKE TO TELLUS ABOUT YOUR FAMILYOR ACCOMMODATION ?WARDROBECHEST OF DRAWERSBEDSIDE LIGHTSTUDY TABLE/DESKCARPET (OR SUITABLE FLOORING)WASH BASINDRESSING TABLEBEDSIDE TABLEMIRRORCHAIRWINDOWOTHERYESNOYESNOBEFORE CONFIRMING YOUR APPLICATION HAS BEEN SUCCESSFUL THE BOURNEMOUTH AND POOLECOLLEGE WILL CARRY OUT A VISIT TO YOUR HOME. AT THE TIME OF APPLICATION PLEASE ADVISE IFYOU ARE UNDERTAKING ANY RENOVATION TO YOUR HOME. YOU WILL NEED TO UNDERTAKE A CRBCHECK FOR ALL ADULTS (OVER 18’S) AT A COST OF £44 PER PERSON, TOGETHER WITH A LANDLORDSGAS CERTIFICATE FOR PROPERTIES WITH A GAS SUPPLY, DATED WITHIN THE LAST 12 MONTHS.DATA PROTECTION ACT 1998THE DATA YOU PROVIDE IN COMPLETING THIS APPLICATION FORM WILL BE PROCESSED IN ACCORDANCE WITH THE PROVISIONSOF THE DATA PROTECTION ACT 1998. PERSONAL INFORMATION WILL BE STORED SECURELY AND WILL ONLY BE USED FOR THEPURPOSE OF ADMINISTERING HOST FAMILY ACCOMMODATION FOR STUDENTS ATTENDING BOURNEMOUTH AND POOLECOLLEGE.IT MAY ALSO BE DISCLOSED TO BANKS IN CONNECTION WITH THE PROVISION OF FINANCIAL SERVICES TO STUDENTS.HOST FAMILY INFORMATION MAY BE REQUESTED BY THE PARENTS OF STUDENTS SEEKING HOMESTAY ARRANGEGEMENTS FORTHEIR CHILD/CHILDREN. SIGNING BELOW WILL CONFIRM THAT YOU ARE HAPPY FOR YOUR DETAILS TO BE PASSD ONTO THEPARENTS. YOU CAN REQUEST A COPY OF THIS INFORMATION AND WE WILL BE HAPPY TO SEND IT TO YOU.I DECLARE THE ABOVE DETAILS ARE CORRECT AND THAT NO PERSON IN MY HOUSEHOLD HAS A PREVIOUS CONVICTION ORRECORD WHICH RESTRICTS MY APPLCIATION TO ACT AS A HOST FAMILY FOR TEENAGERS. I UNDERSTAND THAT THIS WILL BEVERIFIED.SIGNED:DATE:PLEASE RETURN THIS FORM TO:THE ACCOMMODATION OFFICER, THE BOURNEMOUTH AND POOLE COLLEGE, STUDENT SERVICES, THE LANSDOWNE,BOURNEMOUTH, BH1 3JJSS/ACC Rev. 02.12