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 ? *

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

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 ? *

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) *