Host Family Program Survey

If you are interested in having a host family during your stay at Jacobs University Bremen, please complete the following Host Family Survey.

Your Family Name: *

Your First Name(s): *

Your complete Home Address (Street, City, Country): *

Your Nationality: *

Your Gender: *

Your Date of Birth: *

Your Telephone: *

Your Email: *

In the next three fields, please list the countries where you have lived.

Country (1): *

Country (2):

Country (3):

When will you begin studying at Jacobs University?: *

You will enter Jacobs University as:: *

Undergraduate Students: Academic Major (SES): *

Undergraduate Students: Academic Major (SHSS): *

Are you planning to double-major? If yes, what would be your second major?

2nd Major:

Graduate Students: Academic Major:

Number of Brothers and Sisters: *

Religion: *

Hobbies: *

Please list any special interests, musical instruments, pets and hobbies.

Do you smoke?: *

Do you have any special Dietary Needs?: *

Special Dietary Needs:

Do you have any allergies? : *

Allergies:

In the following section, please list the languages you speak and rate your level of conversational ability.

German: *

French: *

Spanish: *

Please list and rate other languages you speak:

As it is not always easy to find a a "Nuclear Family", would you agree to be matched with:

A family with younger children: *

A family with children of your own age: *

A single person with / without children: *

An older couple (with grown up children): *

How have you heard about the Jacobs University Bremen host family program.: *

Jacobs FAQ