Student Application Form

Student Name (s) *

Student ID *

Dear Applicant - All questions need to be answered. If you are not sure what to write, write NA in the space provided. Once we receive the Application an Invoice will be sent to you. Once the Payment has been received we will begin to arrange your Homestay placement. Thank you

Period of Homestay Accommodation ? *

Four Week Homestay

Five Week Homestay

Eight Week Homestay

Ten Weeks Homestay

Are you seeking ? *

Single Room

Twin Share Room (couple or two friends)

Meal Options *

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

Are you Under 18 years and need a Guardian (Carer) ? http://www.homestay-australia.com/guardianship__structure.htm Yes or No *

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) *