1 Start 2 Complete This housing form was developed for participants of SPICE at the VIAA. SPICE is a joint venture of Dordt College and the Gereformeerde Hogeschool. This form provides VIAA with information that is necessary to find a good placement for SPICE students with a host family in Zwolle or Hattem. Attention! This form will also be sent to your host family. Please make sure you fill out the form correctly. Although we do our utmost to find you a placement that meets all your preferences, this might not always be possible. If we are unable to find a placement that meets your smoking preference, food or pet allergies, or mental or physical limitations, we will consult you before matching you up with a host family and will discuss other possibilities with you. North American students Students from the USA and Canada should submit the housing form by October 1 with their other application materials. European students After the selection procedure and acceptance at their home university, students from Europe should submit the housing form. The completed form is due by November 15, along with the following items: Student Emergency Form Motivational letter Questions If you have any questions about housing arrangements and/or this form, please email Rebecca Tervo at Rebecca.Tervo@dordt.edu. If you would like to make changes in your housing form after you are accepted as a student on SPICE, please contact VIAA. You can reach our office by telephone or email until Thursday December 16. If you have an urgent remark or question, call instead of email (+11-31-4255542). If you have urgent remarks or questions you would like to share with us December 16-January 4 (Christmas Break), please use the emergency phone number provided to you in an email from VIAA after you have been accepted as a student on SPICE. After January 4, there will be someone available at the International Office again. VIAA will send you an email as soon as you have been matched to a host family. We prefer to do this before the Christmas Break, but this is not always possible. Keep an eye on your inbox and feel free to contact your host family as soon as you have received their contact information. Most host families love to get in touch with you before your arrival! Personal Information First Name: * Nickname: Last Name: * Date of Birth: * Nationality: * Gender: * Male Female Email Address: * Postal Address * Home Phone: * Please write below a brief letter of introduction to your host family. Your letter should include information about you, your family, your studies, your reasons for going on SPICE and your hopes and expectations for your time in The Netherlands. * Housing information Use five words to describe yourself: * Use five words to describe the people you would like to live with: * My hobbies are: * My vocational goals are: * Describe your knowledge of Dutch: * Do you smoke? * No Yes Would you prefer a home where the family members do not smoke? * No Yes, because: Would you prefer a home where the family members do not smoke? Yes, because: Do you have any food or pet allergies, or any other diet or pet preferences we should take into account? * No Yes, namely: Do you have any food or pet allergies, or any other diet or pet preferences we should take into account? Yes, namely: Do you have any physical or mental limitations that your host family should know about? * No Yes, namely: Do you have any physical or mental limitations that your host family should know about? Yes, namely: Would you like your host family to practice Dutch with you? * No Yes A few host families may have space for two students. If you would like to stay with a roommate, please list your roommate preference: Do you have friends or acquaintances you would like to live close to? If so, please list their names: Housing family options: First Choice: * Family with older kids (12+ yrs) Family with younger kids (0-12 yrs) Couple with no kids (born, or at home) Single Person Second Choice: * Family with older kids (12+ yrs) Family with younger kids (0-12 yrs) Couple with no kids (born, or at home) Single Person How do you feel about living with a single person (a host mom or a host dad)? * My day usually begins at: * Hour Hour01234567891011121314151617181920212223 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 My day usually ends at: * Hour Hour01234567891011121314151617181920212223 : Minute Minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859
