HOMESTAY APPLICATION FORM

How do you know us?(Required)

1. Applicant Details

Applicant Name(Required)

First Last

Name of person completing this form

Gender(Required)

Relationship(Required)

e.g. Mother/Father

Occupation(Required)

Date of Birth(Required)

Mobile Phone Number(Required)

Email(Required)

Enter Email Confirm Email

Blue Card Registration Number(Required)

If you don't have a Blue Card, please write "Need to Apply".

Expiry Date(Required)

2. About Your Family

Other Family Members

Click on right side “+” to add more members

Relationships

Full Name

Gender

DoB

Occupation

Blue Card No.

Expiry Date

Do you have pets?(Required)

If yes, please specify the pet information:(Required)

Name

Breed

Vaccinations

Outdoor/indoor

Character

Please describe the breed, name, vaccinations, outdoor/indoor status and character.

Main Language of Household(Required)

Other Language in Household

Does Any family member smoke?(Required)

Is Smoking allowed:(Required)

Outside

Inside

No Smoking Allowed

Please provide some information about your hobbies and family routines in the box below.(Required)

Does anyone in your household follow any specific diet mentioned above? If yes, please specify:(Required)

5. Health & Safety

Ever been arrested or convicted of any criminal offence, other than a traffic violation?(Required)

If yes, please explain.(Required)

Have a chronic illness, disability or any physical, mental or emotional problems?(Required)

If yes, please explain.(Required)

Have a history of drug or alcohol abuse?(Required)

If yes, please explain.(Required)

6. Payment Info & Notes

Please provide your bank account information for receiving regular payments. Please ensure the information is accurate.

Bank Name

e.g. CBA, ANZ, Westpact.

Account Name

BSB No.:

Six-digit code used to identify the specific branch of an Australian bank or financial institution

Account Number

Digits that identify your bank account at your financial institution

Notes

The information that you enter on this form is privileged and is kept in accordance with the Privacy Act. Under this federal Legislation you are entitled to access any records held on you. For more information on the Privacy Act, please visit – www.privacy.gov.au

I give permission to Shafston international College to share my email address to other homestay for car pooling purposes(Required)