enquiry@iconedu.co.uk +44(0)115 850 0388

*For all persons aged 18 years + in household:

Applicant 1

Title

Forename(s)

Surname

Have you ever been known by another name?

Address

Postcode

How long have you lived at this address?
( If less than 5 years please provide previous address details giving length of time at each to cover 5 years: )

Nationality

D.O.B

Home Tel

Mobile

Home email

Employment

Occupation

Shift pattern

Hours

Employer name & address

Work Tel

Direct Dial

Employee Email

Do you hold a driving licence?

Have you ever been convicted of a criminal offence?

Applicant 2

Title

Forename(s)

Surname

Have you ever been known by another name?

Address

Postcode

How long have you lived at this address?
( If less than 5 years please provide previous address details giving length of time at each to cover 5 years: )

Nationality

D.O.B

Home Tel

Mobile

Home email

Employment

Occupation

Shift pattern

Hours

Employer name & address

Work Tel

Direct Dial

Employee Email

Do you hold a driving licence?

Have you ever been convicted of a criminal offence?

Details of Dependants - all persons under 18 years old:

Dependant 1:

Full name

Relationship to you

Gender

D.O.B

Contact no

Any other information

Dependant 1:

Full name

Relationship to you

Gender

D.O.B

Contact no

Any other information

Details of Host Family Environment:

Please list any specific criteria in relation to accepting a student(s) into your home. (For example - male/ female /non-smoker /age):

Are any members of your household vegetarian/ vegan / pescatarian etc?

Do any members of your household have any food allergies?

Are there any pets/animals in the household?

What interest/hobbies do members of your household have?

Is your household religious? If so which religion and are you practising?

Do you have any holidays booked this year?

Are there any dates which you would not be able to host a student this year?

Are there any dates which you would not be able to host a student this year?

Do any members of your family smoke? If yes, how many?

Does anyone in your household/who regularly visits your household have a criminal record?

Details of home:

Type of property

House

Flat

Other (please state)

Description of student(s) bedroom For example single/double/twin

Is there a private study area available?

ICON Guardianship UK Ltd have Public Liability and Professional Indemnity Insurance. Host families are required to have their own household insurance and to notify their insurers of their foreign students stay. Do you have household insurance? If yes, please provide the policy number and expiry date:

In order to safely transport students in your own vehicle adequate car insurance must be in place. Do you have car insurance?If yes please provide the policy number and expiry date:

Please describe why you want to become a host family for Icon Guardianship UK Ltd:

Could you provide 2 suitable referees for the main applicant? This should not be a family member but could be a work colleague, employer or long-term associate that has known you for a minimum of 2 years. The referees will need to be able to verify your suitability to host international students.

Referee 1

Name:

Email address:

Phone Number:

Referee 2

Name:

Email address:

Phone Number:

Icon Guardianship UK Ltd require each household member 16 years and over to have a DBS check - does each member agree to this? (*Icon Guardianship UK Ltd covers the cost of each DBS check)

Please include any information you feel we have missed that you feel is important for us to know:

All members 18 years and over:
I/We believe all statements to be true and concise at the time of writing:

Signature

Name

Date

Signature

Name

Date

Signature

Name

Date


Please return this form to:

Host Family Co-ordinator
ICON Guardianship UK Ltd
198 Beardall Street
Hucknall
NG15 7JU

Or Email: hostfamily@iconedu.co.uk

If you have any queries please contact Host Family Team on 01158 500394.

Our Next Stage in the application process:
A home visit to meet with family members, to see the home environment and surrounding area and to perform a risk assessment.

Documents we will need to see are:

  • 2 Forms of ID
  • Insurance certificates
  • Gas Safety certificate
  • Current DBS certificate – if available

Thank you for your time in completing this section of the application process.