<p> PRE-ALLOCATION QUESTIONNAIRE UK STUDENT PREFERENCE FORM – HOMESTAY ACCOMMODATION </p><p>This questionnaire is intended to help us find suitable accommodation for you. Please appreciate that it is not always possible to fulfil all your requests. **IMPORTANT** Host families are located within a 4 mile radius of the Bognor Regis Campus. Family Name</p><p>Mr/Mrs/Ms/Miss</p><p>First Name</p><p>What do you like to be called?</p><p>Date of Birth (DD/MM/YYYY)</p><p>Nationality</p><p>Religion* (Optional)</p><p>Address</p><p>Email</p><p>Telephone Number (please include area code) Name of study course with University of Chichester Date Accommodation required from Date Accommodation required to</p><p>Would you prefer to live with a host family in Bognor Regis or Chichester (please note: Chichester has very Bognor Regis limited availability) or Breakfast and evening meal will be provided from Monday to Friday and all meals at weekends. Approximate costs are £110 per week for Bognor Regis and £125 per week for Chichester. Chichester Do you smoke? Yes/No Would you mind staying in a house where the owner may smoke? Yes/No Most of our hosts have pets. Do you have any allergies or phobias relating to animals? If yes, please give details: Would you be happy to stay with hosts who have young children? Yes/No Would you be willing to share a host’s home with another student but staying in separate rooms (only two Yes/No students permitted in any one property)? Do you have any special dietary requirements for religious, health or other reasons? If yes, please give details (please note: you may be required to pay extra for this) Do you have any illness, phobia or disability that needs to be accommodated? If yes, please give details:</p><p>Please return this form as soon as possible to: Private Sector Housing Officer, University of Chichester, Upper Bognor Road, Bognor Regis, West Sussex, PO21 1HR Tel: + 44 (0) 1243 812091 Email: [email protected]</p>