Surname/s: / First Name:
Street Address: / Suburb: / Postcode:
Mailing Address: / Suburb: / Postcode:
Home Phone: / Mobile Number:
Email: / Fax:
Host Mother’s First Name: / Host Father’s First Name:
DOB: / DOB:
Occupation: / Occupation:
Work Phone: / Work Phone:
Driver’s License Number:
Expiry date:
State of issue: / Driver’s License Number:
Expiry date:
State of issue:
OTHER HOUSEHOLD MEMBERS (LIVING WITH YOU)
Names / M / F / DOB / Occupation / School / Relationship to you
HOUSEHOLD INFORMATION
Have you hosted international students before? / / / If yes, how long?
If yes, did you host under 18yr olds or adults?
Is English spoken in your home? / / /
Do any members of your family speak another language? / / /
If yes, please specify:
Please list any other countries you have lived in:
Do any members of your family smoke? / /
Do you object if a student smokes? / / /
Does anyone in your family drink alcoholic beverages? / / /
Do you have any pets? / Allowed: / Quantity:
Is your home close to a
bus stop/route? /
Can you cater for a vegetarian? / /
Do you eat breakfast/dinner together as a family?
What type of foods do you eat for breakfast?
What type of foods do you like to cook for dinner?
Total number of bedrooms in the house: / How many bathrooms do you have?
Would the student be sharing a bathroom with a family member? / /
What bed/s and bedroom/s would be
available for students? / Is there available for students:
Single bed
/ Single bed
/ Single bed
Is the Internet free to use for students?
Double bed
/ Double bed
/ Double bed
/ / / $ p/wk.
Please list any family activities, interests & hobbies:
What do you like to do on the weekends?
Would you classify your family life as: / / /
Would you prefer a male or female? / / /
Would you prefer students’ age: / / /
IF YOU WOULD LIKE TO HOST UNDER 18 STUDENTS,
PLEASE FILL IN THE FOLLOWING DETAILS ABOUT YOUR BLUE CARD:
Name: / Name:
Blue Card No.: / Blue Card No.:
Expiry date: / Expiry date:
Name: / Name:
Blue Card No.: / Blue Card No.:
Expiry date: / Expiry date:
If you need to renew/apply for a Blue Card, please click the link below to fill in the application form
and return it to the college electronically or in person.
WELCOME MESSAGE TO YOUR STUDENT/S
Name:
Signature: Date:
Your signature on this Homestay Application Form permits us to release your information to the student/s and their agencies. Your contact details will also be required in the Homestay Family Lists to be distributed to Agents and other Homestay families hosting the same Study Tour Groups.
Completion of this form does not guarantee a place in our Homestay program. We will contact you when we have a vacancy. Please send or fax your completed application form to: or personally to:
Cairns college of English, Level 1, 67 Lake Street, Cairns QLD 4870 / Fax: 07- 4041 2633