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

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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

GOLD COAST – Student Homestay Application Form

BRISBANE – Student Homestay Application Form

Ready to get started?

Get in touch today