Students International Ltd.

TRESILLIAN HOUSE, 67 DALBY ROAD, MELTON MOWBRAY, LEICESTERSHIRE LE13 0BQ

Tel : +44 1664 481997 Fax : +44 1664 562332 Mobile : +44 7768 865985
email : studentsint@aol.com web site : studentsint.com

APPLICATION FORM - Guardianship Scheme

Student's Details
photo
Name :

Home Address:

__________________________ Postcode : Sex: M/F

Home Tel. No : Fax No : Date of Birth:

Nationality : Passport No: ID Card :

Mobile : Father Mother Student

Email : Father Mother Student

Please send a copy of the students passport & visa (where applicable)with the completed form

Family Background

Fathers Name :

Mothers Name :

Fathers Occupation :

Mothers Occupation :

Names and ages of brothers/sisters :

Are any brothers/sisters already in the UK at school/university ?

Alternative Contact Name & Number : ___________________________________________________

Personal Details

Does your son/daughter like domestic animals ? Yes/No

Are there any animals your son or daughter does not like or is allergic to?

Does your son or daughter smoke ? Yes/NoWhat is your religion ?

Is your son or daughter allergic to any foods ? Yes/No

If yes which ones ?

Is your son or daughter allergic to any medicines ? Yes/No

If yes which ones ?

Does your son or daughter have any other allergies ? Yes/No

If yes which ones ?

Does your son or daughter follow any special diets ? Yes/No

If yes please advise

Does your son or daughter suffer from any illness ? Yes/No

If yes please identify

Does your son or daughter regularly take medication? Yes/No

If yes please advise

When did your son or daughter last see a doctor ?

Name and address of family doctor :

Has your son or daughter been away from home before ? Yes/No

If yes, for how long ? Did he/she find it easy/not easy ?

What are your son/daughters favourite sports ?

What does your son or daughter like to do in his/her free time ?

Please ask your son/daughter to write 100 words about his/herself, hobbies, interests, sports and family

Education

Where is your son/daughter studying now ?

Recent Examination Results (please enclose copy of 2 latest school reports) :

Please list previous schools and dates :

How many years/months has your son or daughter studied English ?

How many hours a week ?

Does he/she speak and understand English? Excellently Well Fair Beginner

Has he or she taken any English examinations other than in school? If so, please enter dates and grades :

English Examination (IELTS/Cambridge/Trinity) ___________________________________________

Date and grade achieved : ______________________________________________________________

Does your son or daughter speak other languages ?

New School Details

Name and address of school :

When will your son/daughter start this school ?

Will he/she be a full time boarder? Yes/NoWhich year or form group ?

Does the school have compulsory exeats/weekends out?

What are your son/daughters best subjects ?

Will your son/daughter join the pre-sessional course at Students International Study Centre? These are run

in July/August Yes/No

Please indicate dates preferred for pre-sessional course ______________________________________

Other important information you need to tell us

Terms and Conditions

1. Students International Limited undertakes to ensure that every effort is made to place students in
friendly, reliable host families, where possible with children of a similar age group. Each family will
have received a personal visit from the Director or company representative.
 2. Shoplifting, taking drugs, drinking of alcohol in public places (under 18 years of age), or consistent
misbehaviour will not be tolerated. Students are subject to UK law whilst in the country.

3. Any damage incurred by the student to school or host family property will be invoiced to the parents or
guardians.

4. Students International Limited has full public liability insurance but each student is advised to have
personal cover for accidents, lost luggage, damage to computers etc. Students International can advise
on personal insurance.

5. Where Students International Limited purchases flight or rail tickets for students, or distributes pocket
money, parents are asked to refund the full amount immediately by payment to the local bank of
Students International Limited or to the main account at the HSBC Bank, Melton Mowbray,
Leicestershire

6. All invoices should be settled by the due date.

7. Students and their parents are responsible for ensuring that their travel documents and visas (where
required) are complete, current and valid. Mrs Blythe of Students International Limited will help with
visa application paperwork where required.

8. One terms notice of cancellation is required. If notice is not received, a cancellation fee of one terms
administration fee will be charged at the current rate.

9. Parents need to be aware that on occasion Students International may need to divulge personal
information to a third party such as in the case of an accident.

10. Students International may wish to publish photographs of their students on the website (without naming
them). Please initial if you do NOT give permission for this to happen.

11. Parents agree that in the case of cancellation of this agreement with Students International Ltd they
undertake not to make contact with any host family in connection with new guardianship arrangements.

12. Any disputes or claims between Students International Limited, the students, or their parents/guardians
will be subject to British law through the Leicestershire County Court.

I agree to abide by the rules and conditions laid down by Students International Limited, a copy of which I have kept.
I appoint the Company to act on my behalf in cases of emergency or if we cannot be contacted.

Signed :

Father Mother

Date Feb 2017 (rev)