<p>HOUSING QUESTIONNAIRE (Photo)</p><p>Deadline for applications:  April 15th for Summer Semester (June / July)  May 15th for Summer Semester (July)  June 15th for Fall Semester  November 15th for Spring Semester</p><p>The purpose of this questionnaire is to help us make your stay in Spain more comfortable. Please, answer this form in capital letters.</p><p>Your answers to the following questions will help us determine the most appropriate home stay arrangements for you. This is a confidential document, so the details provided below will not be shared. Please remember to be honest, direct, and sensitive to your needs.</p><p>About yourself.</p><p>Full name: My family and friends call me: Age: Date of birth (day/month/year): Place of birth: Nationality: Sex: Passport number: E-mail: not university email but addresses like gmail/hotmail/yahoo etc...</p><p>Facebook: Institution: Period of study Fall Spring June July Year 20 Which is your major? ______and minor? Father’s name: Mother’s name: Brothers and sisters: </p><p>In case of an emergency please call: Father mother brother/sisterother Name: Address: Zip Code: City: State: Home phone: Office phone numbers: E-mail: </p><p>1</p><p>Give a brief description of yourself, your personality and your hobbies:</p><p>Height ______Weight ______</p><p>How do you consider yourself? Talkative orderly independent peaceful Affectionate reserved studious extrovert</p><p>Any peculiarity that you think we should be aware of?</p><p>In the last few years, whom did you use to live with? On your own With other student/s or friend/s With your family</p><p>What is your Spanish level? Bilingual Advanced Intermediate Beginner</p><p>Have you ever lived in a foreign country before? Yes No Where? How long? </p><p>How was your experience? Explain:</p><p>Have you travelled to other countries? Yes No Which ones? </p><p>How was your experience? Explain:</p><p>2</p><p>Will you be travelling often? Yes, I’ll be travelling as much as I can. Yes, but not as much as I want No, I won’t be travelling</p><p>Smoking Preferences: Do you smoke? Yes No Do you mind if someone in your host family house smokes? Yes No</p><p>Medical Conditions. Do you have a health insurance? Yes No </p><p>Do you have any medical conditions that the family should be aware of? Yes No</p><p>If yes, please explain any medical conditions that may affect your housing stay:</p><p>Do you have any allergies? Yes No </p><p>If yes, please explain </p><p>About Religion:</p><p>Is religion important in your life? Yes No Does your religion affect your meals? Yes No Would you prefer to be with a family of a certain religious affiliation? Yes No If yes, please explain: </p><p>Note. Instituto Franklin cannot guarantee a particular placement and students should be open to living with a family of any religion.</p><p>About food: Do you have any restrictions about meals or food that we should be aware of?</p><p>Yes No</p><p>If yes, please, explain what food you don’t eat: </p><p>3</p><p>I want to taste all kind of food There are meals that I don’t like. They are </p><p>IMPORTANT: Please, notice that students with special dietary needs will have to pay 2€ more per day due to the high cost of special dietary products</p><p>Free time: What hobbies or sports would you like to participate in while staying in Alcalá?</p><p>When do you usually go out? The whole week Weekends Wednesday to Saturday Once a week</p><p>HOUSING OPTIONS Check your accommodation in order of preferences. Exact location of housing will not be provided until your arrival overseas. All housing requests are subject to availability and we do not guarantee that your requests can be accommodated. We’ll do everything possible to accommodate you based on your first choice however, in some instances we cannot meet your expectations due to the unavailability of families and/or rooms at the residence. Last minute changes can happen due to family and program needs. </p><p>Home-stay 1 2 </p><p>Dorms CRUSA 1 2 </p><p>1. Home-stay with a family in Alcalá: </p><p>Living with a family includes three meals per day (7 days a week, laundry once a week and a maximum of two students per home stay, from your program or from a different university). </p><p>What kind of family would you like to have? Check your preferences from 1 to 5; (1= first choice, 5= last choice)</p><p>Full Family Mother & children Couple Single Retired</p><p>Would you mind living with pets? Yes no Would you mind living with small children? Yes no Would you mind living with elderly people? Yes no Will you be spending some of your free time with your family? Yes no Would you prefer to be alone in the house or with another partner? </p><p>4</p><p>If yes, please write down his/her name and college. </p><p>Note: Men and women are not allowed to live in the same house.</p><p>What are your expectations about living with a Spanish family? Please, explain in order of preference. </p><p>2. Living in CRUSA. Distance: 15-20 minutes by bus from the Instituto Franklin and Alcalá downtown. </p><p>- Apartments for 8 people: One kitchen and two bathrooms. - Double rooms. - Mail, fax, and message service reception. - Water, electricity, and gas usage. (Excess above 40€ per month will be billed proportionally to all the house residents). - Arriving from Madrid. The bus company, Continental Auto, runs buses from Avenida de América subway stop to Alcalá. Bus number 227 goes to campus. - To arrive from Alcalá de Henares downtown. Bus lines 2 and 3 connect Plaza de Cervantes with the campus.</p><p>Note: students with tobacco allergies should be aware that smoking is not prohibited at the dorms. </p><p>VOLUNTEERING WHILE IN ALCALA (Just for the fall and spring programs)</p><p>Would you like to volunteer? Yes No </p><p>Instituto Franklin offers the possibility of volunteering at:</p><p>1) Schools: Helping students with their English skills Helping teachers with their English skills Playing, singing, staying with children after school hours </p><p>2) Special Education school, taking students out on weekends to the movies, for walks, on day trips. Volunteers will always be accompanied by personnel from the school.</p><p>3) Spending time at the hospital with elderly people: taking them out for walks, talking to them </p><p>Important: if you are not sure about volunteering or think that you will not be able to commit to a certain number or hours per week, it is probably better not to choose this option. </p><p>WE WILL TRY TO DO OUR BEST BUT WE CANNOT GUARANTEE TO COVER ALL OF YOUR EXPECTATIONS. </p><p>I certify that the information I have provided above is accurate. I hereby agree that I am bound by the policies and conditions associated with the program-related housing provided by Instituto Franklin.</p><p>While I understand that Instituto Franklin appreciates all of the information I have provided in this Homestay Questionnaire, I acknowledge that Instituto Franklin cannot guarantee that my preferences will be met.</p><p>5</p><p>Instituto Franklin and host families will only provide housing during the program. Those students who choose to arrive before or stay after the end of the program will be responsible for their own accommodation. </p><p>Signature:</p><p>6</p>