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.

Information on our Student Service Center and the Jacobs Host Family Program can be found on the Student Services Center web page.

Your Family Name *

Your First Name(s) *

Your complete Home Address (Street) *

Your complete Home Address (City, State) *

Your complete Home Address (Country) *

Your Nationality *

Your Gender *

Your Date of Birth

Month

Day

Year

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 *

Preparatory programs *

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 *

Do you smoke? *

Do you have any special Dietary Needs? *

Special Dietary Needs

Do you have any 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 (age 0 to 6) children *

A family with children of your own age *

A single person with / without children *

An older couple (with/without grown up children) *

I agree that my details will be passed on to my host family *

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

Why is it important for you to get a host family? *

What do you have to offer to a potential host family? *

Privacy Policy *

I acknowledge by submitting this form my data is available to this institution. Privacy Policy