Homestay Application

Homestay is one of the most important experiences for an international student and is the basis on which students will remember their time in Australia.

Please complete the below form:	* Mandatory fields

Personal Details		Partners Details
Title *	Mr Mrs Miss Ms Dr	Title	Mr Mrs Miss Ms Dr
Surname *		Surname
Given Names *		Given Names
Date of Birth *		Date of Birth
Mobile		Mobile
Work No.		Work No.
Occupation *		Occupation
Email *		Email
Do you hold a current Child Suitability Card (Blue Card) ? * Yes No		Do you hold a current Child Suitability Card (Blue Card) ? Yes No
Card No. & Expiry Date		Card No. & Expiry Date

Accommodation Details
Number / Street *		Suburb / City *
State *		Postcode *
Home Phone *		Facsimile
Brief description of house *
Brief description of student's room *
How many students can you accommodate? * (student's must have their own bedroom)
Does your family have any food restrictions?
Can you accommodate vegetarians? Yes No
Can you accommodate Halal? Yes No
Do you have any pets ? Yes No Outside only
If you do have pets, please specify
Is smoking permitted ? Yes No Outside only
Do you have internet access which students can use? Broadband Dial-up No

Other persons in Household
Please list all of your children and any other persons who reside in your home. Include their Name, Date of Birth, Relationship to you, Occupation and whether they are living at home.
Please provide the Blue Card details for all persons over the age of 18 living within your household.
Religion Affiliation?			Do you attend regular services?
Does any member of your family speak another language? Yes No
Family interests & activities (eg sports, camping , BBQ's)

Student Preferences
Gender *	Male Female Either Couple
Age *
Length of Stay? * Short Term (4 weeks) Long Term (5+ weeks)
Interested in Intensive Language & Cultural Program (ILCP) ? Yes No
Intensive Language & Cultural Program (ILCP) 'Study Tours' are designed for overseas Primary & Secondary school students studying in Australia for approx 1-4 weeks only. Students are placed in pairs and require 3 meals and escorting to/from the city daily. Reimbursement is $30/night per student.

Transport Details
Distance to closest bus stop / train station (in metres)
Name of closest train station		Travelling time to city
How many bus zones to city		Is private transport available?
Are you happy to disclose your address details to other homestay families for car-pooling purposes (mainly for ILCP) ? Yes No

Other
Does your home & contents insurance include public liability cover (which covers boarders) ? Yes No
How did you hear about our homestay programme?
Is there anything else that you think we should know about your circumstances?
Once we receive your completed application form, an inspection of your home will need to be arranged. We request that both partners (if applicable) are home during the inspection. What is the most covenient time for the Accommodation Coordinator to visit your home and meet your family?
Please Note: allow up to four - five weeks for an inspection to be arranged. If you have not heard from a staff member after four weeks please contact the Accommodation Coordinator.

Declaration

I certify that the information provided is true and correct and understand the responsibility of being a homestay provider with Sarina Russo Schools | Australia. I will inform Sarina Russo Schools | Australia if there are any changes to this information in the future.

I would like to be contacted by and receive information fromSarina Russo Schools | Australia. Your information will be handled in accordance with our Privacy Policy and Disclaimer.

I Agree I Do Not Agree