Personal Details

Family Name*

Given Name*

Date of Birth (DD/MM/YYYY)*

Sex*

Male Female

Home Country*

Language spoken*

Religion

Contact Details

Email address*

Phone number*

Fax number

Home Country Emergency Contact Details

Name*

Language spoken*

Email address*

Phone number*

Fax number

Course Details

Student Number

Course/s of study*

Campus of Study*

Arrival Details

Expected date of arrival (DD/MM/YYYY)*

Expected duration of stay*

Homestay options

Profile Questions

Do you want to live in a household with children?*

Yes No Either

Do you smoke cigarettes?*

Yes No

Can you live in homestay with a pet?*

Yes No

If you have answered NO please explain why.

What are your hobbies/interests?*

Please describe your personality*

Is there any food that you do not eat?

Do you have any special needs

I understand that all information supplied is correct to knowledge at the time of writing and any misinformation may result in the forfeit of the Homestay booking without refund of fees.*