S L Student Information Sheet

Your Teacher Responsible: Group Ref No:

This information will help us to place you with a suitable family
Please print if handwritten
Family name: VOICU...........................................................
Given names: DAVID ANDREI............................................
Male/Female: M....... Date of Birth: 13.02.2008...............
Nationality …ROMANIAN……………………………………………………
School: National Bilingual College “George Cosbuc”..........
Town/City: BUCHAREST.....................................................
Home Address: ...................................................................
............................................................................................
E.Mail: anamaria.zama@gmail.com…………………………………………………………..
Passport No. (if visa is required) ………………………….

Family Information
Father’s Occupation: MANAGER............................. Mother’s Occupation: PROFESSOR.......................
Brothers/Sisters at home: ONE BROTHER.................................... Ages: ..............................................
Do you have any pets……NO - I am allergic ……………………………………………..
Medical Information
Allergies requiring medication only: NO......................................................................................................
Are you on any medication prescribed by a doctor? ......................................................................................
Any other info.: allergic to animals, allergic to gluten .....................................................................................
(Any personal medical problem please inform your teacher)

Do you smoke?......NO..............................................Are you vegetarian? NO...............................................

Do you require a special medical diet? (there is an extra charge for Celiac, gluten free, diabetic & lactose intolerant diets)
I am on a gluten free diet……………………………….....................................................................................
How do you like to spend your leisure time? I like visiting new places, talking to my friends and playing
video games....................................................................................................................................................
........................................................................................................................................................................
How would you and your family assess your character and personality? I am a responsible, sensitive and
eager to learn..................................................................................................................................................
........................................................................................................................................................................
If possible please base this on the Common European Framework levels
I have been studying English for ....7.......... year(s) Level: ...B1............................................................
Have you been to England before? If so, when and where? Yes, in Devon...................................................
Have you ever taken part in a SOL course? If so when. Yes, last year..........................................................

We invite you to add any extra information in order to help with placements with host families, e.g. If you have been
before and wish to stay with the same family please state the name of the family. (We will do our best to place you
with your chosen family).
………………………………………………………………………………………………………………………………………………………
The form need to arrive at least 4 weeks before the course begins.
G4-Oct 2016