Surname  

Email

Home Phone Work Phone Mobile

Father's Name    

Occupation  

Birth Date

Mother's Name 

Occupation

Birth Date

Child   

Occupation

Gender

 Year of Birth  

Child   

Occupation

Gender

 Year of Birth  

Child   

Occupation

Gender

 Year of Birth  

Police Check Completed   

Can you offer Work Experience at your place of Work ?         Work Experience Duties ?

Address  

Suburb Postcode

Distance to the CBD (Central Business District -)        

Describe the area you live in (what  is close by, area features etc)

Home :  Single Storey Home    Two Storey Home     

Home Type :  Apartment   Townhouse House

Smoking Allowed   Languages Spoken at Home

Internet Access :  Dial Up   Broadband   Wireless

Number of Single rooms available for students ?

Your Interests, Hobbies ?   

Pets

Other International Students Currently in the home : (Gender ?  Age ? Nationality ?)

Providing Three Meals per day is a requirement. Can you provide Halal Meals ?      What are Halal meals ?

TRANSPORT

Transport :  Available :  Train Tram   Bus    

Walking time to Transport ?  

Total time to travel to school

If two modes of transport required, advise i.e.:  (Bus then train etc)

How did your hear about Homestay Australia ?

Students preferred (Male or Female  - Number of Students)

     Please read the HOMESTAY AGREEMENT

I have read the Homestay Agreement and I accept the Conditions of Homestay Australia P/L.

       I accept the Conditions of Homestay Australia P/L.