Host Family

Dear Student,

This application form for accommodation aims to analyze your profile and find an accommodation that suits your needs well. It is therefore very important to fill in the details on the form as completely as possible.

• The value of the accommodation per vacancy is R $ 550.00 (five hundred and fifty reais) per month

**• * The period of the stay for an exchange student in the occupancy may vary from 6 (six) months* or 1 (one) academic* year in Univille

• The responsible for the accommodation and the exchange student must sign the Adhesion Term for the period requested by pledging to follow the laws of Univille present the program regulation.**

* or less, not required.

Student Name:

Nationality:

Gender:

male

female

Special Requirements (e.g. disabilities):

yes

Which:

Cidade:

Country:

Course at Univille:

E-mail:

Exchange period (From):

/ /

(MM/DD/YYYY)

Exchange period (To):

/ /

(MM/DD/YYYY)

Mobility Program Coordinator:

E-mail:

Address (street, number, post code, city and country):

Exchange Framework:

Cooperation Agreement

other

(other) which?:

University of Origin:

Course at the University of Origin:

Accomodation Type

Please indicate how many months you will be needing accommodation:

Please, indicate your choice by order of preference (1st, 2nd, 3rd)

Host Family – Single room:

Host Family – Double room *:

Hostel – Private Accommodation:

* In this option you will be sharing the accommodation with someone of the same gender and similar age.

Language Skills

Language 1:

Nível:

basic

intermediate

advanced

fluent

Language 2:

Nível:

basic

intermediate

advanced

fluent

Language 3:

Nível:

basic

intermediate

advanced

fluent

Personal Information

Please, write a report on your daily routine, stories, the university, friends, family, travel etc. It is important to describe with many details as possible, then it will be easier to find suitable family profile.:

Signature::

Data:

/ /

(MM/DD/YYYY)