Surname             Email     Skype Address  

Home Phone Work Phone Mobile

Address  

Suburb State     Postcode

Male Parent's Name    

Occupation  

Birth Date

Female Parent's Name 

Occupation

Birth Date

Child   

Occupation

Gender

Year of Birth  

Child   

Occupation

Gender

Year of Birth  

Child   

Occupation

Gender

Year of Birth  

Police Checks Completed    Date of Police Checks      

(For all members of the family over the age of 18 years. Forms are available from your local Police Station. The placement of a student with you cannot be made until we have a copy of your Police Check record )

OR

Working with Children's Check (Card). Card Numbers   

(For all members of the family over the age of 18 years. Forms are available from your local Post Office. The placement of a student with you cannot be made until we have a copy of your WWCC)

Distance to the CBD (Central Business District -)        

Which Secondary Schools, TAFE Colleges and Universities are within 45 minutes by Public Transport from your home.

Smoking Allowed   Languages Spoken at Home

Internet Access :  Dial Up   Broadband   Wireless

Number of Single rooms available for students ?

Is your Accommodation :  An Apartment    A Home   A Bungalow 

Is your

Your Interests, Hobbies ?   

Pets

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

What meal plans can you provide per day :

 3 Meals           :  Yes   No

 2 Meals           :  Yes   No

 Breakfast Only :  Yes   No Students may need access to your kitchen to cook their meals. They are  required to leave the Kitchen as they find it.

 No Meals        :  Yes   No Students may need access to your kitchen to cook their meals. They are  required to leave the Kitchen as they find it.

Can you provide Halal Meals ?   Yes   No    What are Halal meals ?

TRANSPORT

Transport :  Available :  Bus    Train Tram    

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 PL.

 I accept the Conditions of Homestay Australia PL.      

Please provide pictures of either yourself and your family, your home or the bedrooms you are letting. Email them to info@homestay-australia.com

Thank you.