Please provide the following Student information:

School Coordinator's Name
School Coordinator's Email Address
School Coordinator's Contact Number
School	Name                  Course  Which State       Country
Student's Name
Student's Nationality
Student's Mobile Phone Number	Student's Skype Address
Student's Email Address

Date of Birth
Gender	Male Female

Meals :

Does the Applicant require -

    3 Meals per day (Breakfast Lunch and Dinner)        

    2 Meals (Breakfast and Dinner, Monday to Friday ; 3 Meals (Breakfast, Lunch and Dinner, Saturday and Sunday) 

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

   Breakfast Only           

    No meals provided 

A home with Children ?         With Children       Without Children         Either  

                                                            
Pets  (Dogs & Cats) ?  No Pets        With Pets     Either

Airport Transfer Required ?     Yes       No    

Please advise your flight details if you have them. If you do not require Airport Transfer your flight details are required so as your homestay can be informed.

Date       Time       Flight Number 

Accommodation Start Date : -- dd/mm/yy

Halal Meals required ? Yes No

Any Special Requests ? 

The School agrees to the Conditions of Homestay Australia PL as specified in the section HOMESTAY CONDITIONS       YES