Dieser Fragebogen dient dazu, Deine grundsätzliche Eignung für den Schüleraustausch nachzuweisen, aber auch, um einen Austauschpartner und eine Familie zu finden, die zu Dir passen und zu denen Du passt.
Bitte den Fragebogen an die folgende E-Mail Adresse per E-Mail bis zum 22.9.17 schicken:
1. BASIC INFORMATION
Name:
Age:
Siblings (how many, ages):
Can you ride a bike?yesno
Can you swim?yesno
Do you have any phobias?yesno
If so, explain:
Are you more indoorsy or outdoorsy?Underline.
Are you a night owl or an early bird?Underline.
Describe your typical day:
Describe your ideal day:
Do you have experience abroad?Describe.
How would you describe your level of comfort with English?
Do you like animals? yesno
To which animals are you allergic?
Do you have pets at home? yesno
Special interests or activities in the family:
2. SPARE TIMEHow do you spend your free time?
Please check (x) all that apply
Also circle the frequency: (1) often(2) sometimes(3) never
Reading123Computer games123
Boardgames123Meeting friends123
Watching TV123Watching movies123
Doing/seeing art123Facebook/Skype/Texting 123
Shopping123
What type of literature do you like?
Do you do sports? 123
What type?
Do you play a musical instrument?123
Which one(s)?
Do you listen to music?123
What type/band names?
Other spare time activities?
To which clubs/organizations do you belong?
In which organized (after school) activities do you participate?
What kind of job do you have? How much time does it take?
What specific chores do you have to do at home? [Inwiefern musst du im Haushalt mithelfen?]
3. SCHOOL
Why do you apply for the student exchange? What do you hope to get out of it?
(Write between 80 and 150 words!)
What are your favorite subjects?
How far is your home from school?
How will your guest get to school? Underline.
by walkingby bikeby carby bus
4. PERSONALITY DESCRIPTION
Please tell us about yourself according to the following
1 = not at all or never2 = slightly or rarely3 = moderately/sometimes 4 = very much or often5 = exclusively or always
extroverted___adaptable ___stubborn ___
calm ___sense of humor ___lone wolf ___serious ___
shy ___open-minded ___adventurous ___
friendly ___emotional ___religious ___talkative ___
introverted __organizedpatient __lively___
group-oriented ___easy-going ___ironic/sarcastic ___
mature ___reliable___
Please list your FAVORITES....
Food:
Singer:
Sport to watch:
Athlete:
Movie:
TV show:
Place in your house:
Animal/Pet:
Drink:
Website:
Which three things would you take to a deserted island?
What do you not eat or dislike?
5. IN YOUR HOST FAMILY
Would you mind sharing a room with your host brother or sister?YesNo
Will your guest have his/her own room?YesNo
Exchange partner preference: (underline!)
girl onlyboy only
prefer girl, boy OKprefer boy, girl OK
How would you characterize your family?
Please indicate (x)
easy-going___quiet___serious___
strict___family-oriented ___ communicative___
What does your family like?
Attend sports events (of family members or public?)
(1) Seldomly(2) sometimes(3) often
Play games ___Play music___Vacation together ___
Have family discussions___Eat meals together___
Attend cultural events ___
6. HEALTH INFORMATION
Which health restrictions do you have?
Do you take a certain medication regularly?Yes No
If so, which?For what condition?
Do you have any allergies?YesNo
What are they?
What has to be done if the allergy arises?
Do you follow a special diet, either out of necessity or by preference? If so, please describe.
7. FURTHER INFORMATION
Further information you consider to be important:
I have answered this questionnaire truthfully and to the best of my knowledge.
Place, Date: ______
Name of applicant: ______
Please e-mail this questionnaire to the following e-mail address: