Apply for
Home-Stay Placement
Fill out this form below and apply for home-stay placement today.
Please complete the form below to apply for home-stay placement
Your Details
Family Name
Given Names
Date of Birth
Gender
Nationality
Religion
Address
Email Address
Telephone Number
Next of Kin Details
Contact Name
Relationship to You
Address
Email Address
Telephone
About You
Which languages do you speak?
Level of english
Have you lived away from home before?
Do you like children in the family?
Do you like cats & dogs?
Do you smoke?
Do you have any allergies, medical conditions or special needs?
Please give details
Do you take medication?
Please give details
Are there any foods that you dislike?
Please give details
What are your hobbies and interests?
Please tell us a little about yourself and the type of family that you would like to stay with?
Agent's Details
Company
Agent's Name
Telephone
Email Address
Place of Study
Are you studying in Brisbane or the Gold Coast?
Name of School
Course
Location
Start Date
Finish Date
Date of Arrival
Time of Arrival
Airline
Flight Number
Airport of Arrival
Homestay accommodation dates required
Start Date
Depart Date
Package Inclusions
Accommodation placement fee
Homestay Options Per Week
Number of Weeks
Overseas TT or Credit Card Bank Fee
If you are unable to complete the form please fill out the attached form below
Ready to get started?
Get in touch today