"*" indicates required fields

    Contact phone number*

    Your date of birth:*

    Contact email*

    l. What level of Spanish will you have completed before leaving for Spain? Native Speaker?*

    2. Do you have allergies?*

    If so, to what, and how severe are they (Please be detailed). Will you have an EpiPen with you in Spain?

    3. Do you have a preference to live in a Spanish home without any pets (dog, cat, other)? Please indicate (eg. “No dog,” “No cat,” “No preference”):

    4. What are your expectations of the persons in your Spanish home?:

    5. How would you describe yourself (outgoing/reserved; late/punctual; keep a neat room/rather disorderly; patient; assertive; tactful; responsible; diplomatic. etc.):

    6. Are you open to eating new and different foods than you are accustomed to eating at home? Are you a vegetarian, vegan …?

    7. Is there anything that your Spanish host(s) should know about you (i.e., special needs)?

    Applicant’s signature / name:

    Date:

    By including my name and date I hereby certify that all the information I have provided on this application form are correct.

    In accordance with the established Organic Law 15/1999 for the Protection of Personal Data, the information collected in this document is included in an automated processing file belonging to Richard Crescenzo D’Augusta (Tax I.D. # X2676498B), trade name (CEHS), in compliance with the security measures required by law, for the purposes that are clear from this document; the user reserves the right to access, rectification, erasure or objection by means of a written petition, together with a copy of a valid I.D. card, to the following address: C/San Valentín, 12, Entresuelo A, 40003, Segovia, España.