Application Form for Homestay or Shared House.

Answer every question please. If you are not sure just write NA.

Name (s) *

Student ID (If applicable) *

Mobile Number (Australian) (if you have one) *

Email Address *

What Accommodation Type are you seeking? *

Homestay With Meals provided

Shared House with No Meals provided

Meal Options for Homestay
(Costs will vary depending upon the Meals requested and the location of the accommodation) *

3 Meals per day x 7 days per week

2 Meals per day x 7 days per week (Breakfast and Dinner)

3 Meals (Weekends) & 2 Meals (Weekdays)

For how many weeks or months do you need the accommodation *

Do you need Internet Access *

Room required? *

Single Room

Twin Share Room (Must be a couple or two friends)

Nationality *

Birth Date *

Gender *

Male

Female

School / University *

School / University Address *

School Start Date *

Agency Name (If you have an Agent) *

Agent Email Address (If you have an Agent) *

Do you wish to live with Children *

With Children

Without Children

Do Not Care

Do you wish to have Pets in the home *

With Pets

Without Pets

Do Not Care

Do you have a Medical condition which may affect your living requirements ? *

Do you smoke ? *

Is Airport Transfer required (If not, we will still need the details to advise your Host of your arrival. Send them when they are available) *

If Yes, Arrival Date *

If Yes, Arrival Time *

If Yes, Name of Airline *

If Yes, Flight Number *

Homestay Start Date *

Any Special Requests *

Do you Accept our Terms and Conditions ? (Refer to our website - Student Information / Predeparture information) *