subject_line
Application Form
Student Name (s)
*
Student ID
*
Answer every question please. If you are not sure just write NA. Thank you for visiting.
Period of Homestay Accommodation ?
*
Two Week Homestay
Four Week Homestay
Five Weeks Homestay
Weekend Homestay
Are you seeking ?
*
Single Room
Twin Share Room (Must be a couple or two friends together at the same time)
Meal Options
*
Accommodation for Chores
No Meals Provided
Breakfast Only Provided
3 Meals per day x 7 days per week
2 Meals per day x 7 days per week
3 Meals per day (Weekends) & 2 Meals per day (Weekdays)
Shared Room - 3 Meals per day x 7 days per week
Shared Room - 3 Meals (Weekends) 2 Meals (Weekdays)
Shared Room - 2 Meals per day x 7 days per week
VIP Homestay Accommodation
Do you need Internet Access
*
Nationality
*
Birth Date
*
Gender
*
Male
Female
School / University
*
School / University Address
*
Course Start Date
*
Student Email Address
*
Agency Name
*
Agent Email Address (If you have an Agent)
*
Children
*
With Children
Without Children
Do Not Care
Pets
*
With Pets
Without Pets
Do Not Care
Do you have a Medical condition which may affect your living requirements ?
*
Do you smoke ?
*
Arrival Information
Is Airport Transfer required
*
Arrival Date
*
Arrival Time
*
Name of Airline
*
Flight Number
*
Homestay Start Date
*
Any Special Requests
*
Do you Accept our Terms and Conditions ? (Refer to our website - Student Information / Predeparture information)
*