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Student Online Application

* indicates mandatory field.

Application
Application Type *
Do you have an agent? * Yes   No
 
Personal Details
Family Name *
Given Name *
Gender * Male   Female
Date of Birth *
Nationality *
Passport Number *
 
Your contact details in your home country
Address Line 1
Address Line 2
City
Zip Code / Postcode
Country
Telephone
Mobile
Email *
 
Education
Campus / Institution of Study in Australia
Current / Most recent education institution
Please select your English speaking ability Excellent   Good   Fair   Low
 
English language proficiency
TOEFL
TOEIC
IELTS
Other
 
Characteristics
Please indicate your main Purpose for undertaking Homestay
Please list your interests and/or hobbies? (e.g. sports, musical instruments, art, etc.) (max 200 characters)*

Are there any aspects of your lifestyle which may require your Homestay family's cooperation, for example: fasting, religious activities, certain festivals, celebrations, prayer, etc? (max 200 characters)
Please briefly describe your personality (max 200 characters)*
Please list any foods that you cannot eat or prefer not to eat (max 200 characters)
Please write a short message to your host family.(max 1000 characters)*
Have you ever been convicted of a crime or offence in any country? * Yes   No
If yes, please provide details (max 500 characters)
 
Medical
Do you currently have any allergies? * Yes   No
If yes, please provide details (max 200 characters)
Have you ever had any other allergies that you have not listed in response to the previous question? * Yes   No
If yes, please provide details (max 200 characters)
Do you currently take any medication or require any treatment for any medical condition? * Yes   No
If yes, please provide details (max 200 characters)
Have you ever been required to take any medication or to receive any treatment for any medical condition? * Yes   No
If yes, please provide details (max 200 characters)
Do you currently have or have you ever suffered from any other medical or psychological condition that may be relevant to or impact upon your homestay arrangements? * Yes   No
If yes, please provide details (max 200 characters)
Please confirm that you are suitably healthy and fit to participate in the Homestay arrangements. * Yes   No
If no, please provide details (max 200 characters)
Blood Type A   B   O   AB 
Checked if known RH+   RH- 
 
Homestay Preferences   (We will make the best possible match but cannot guarantee that all your preferences will be met)
Would you live with a family that has another Homestay student Yes    Indifferent    No
Do you smoke? * Yes    No
Would you live with a family that smokes? Inside  Outside       No
Do you drink alcohol? Yes    No
Would you live with a single mother? Yes    Indifferent    No
Would you live in a single person household? Yes    Indifferent    No
Would you live with a retired couple? Yes    Indifferent    No
Would you live with teenage children? Yes    Indifferent    No
Would you live with young children? Yes    Indifferent    No
Would you live with a family that has pets? *

(Please note that the majority of Australian households have pets.  It may be impossible to place you with a family that does not have pets.)

 Inside  Outside       No
Are you a vegetarian? * Yes    No

Are you a Muslim student? *

 Yes    No
Is there anything else that you would like us to know? (max 200 characters)
 
Emergency Contact
Name *
Relationship to applicant *
Address line 1
Address line 2
Zip Code / Postcode
Country
Telephone *
Facsimile
Email
 
Guardian