HOMESTAY FOR INTERNATIONAL STUDENTS

HOST FAMILY APPLICATION FORM

  1. Family Name:______

First Name: (Husband)______

First Name (Wife) ______

  1. Home Address:______

______

  1. Post Code
  2. Telephone Number: Home______

Work ______

Mobile ______

  1. Fax Number: ______
  1. Email address: ______
  1. Best time to contact you:______

OFFICE USE ONLY

Visited by:______

Date Visited:______

Date Entered:______

Contract/Profile sent: ______

ACCOMMODATION DETAILS
  1. Please list all members of your household (including yourself) and their relationship to you.

Name / Relationship / Gender / Age
  1. Please list family past-times and interests.

______

  1. Please list any language other than English spoken by family members, including their level of fluency (ie: beginner, intermediate, advanced, native speaker)

______

  1. How many rooms do you have available for international students? ______

Single room accommodation ______Twin room accommodation ______

Type of dwelling? (Please circle)HouseTerrace

Unit

  1. Please briefly describe your home, ie: size, location, condition etc.

Do you have any pets? ______

If you have pets please specify the type ______

  1. Does anyone in your household smoke? ______

Do you allow smoking at home? Inside Outside

No where

  1. How many kilometres from the University is your home? ______
  2. How might an international student staying in your home get to the University. (Specify mode of transport, route, time etc)

______

  1. Occasionally some students have special dietary requirements (eg: vegetarian).

Are you willing to accommodate students with special dietary requirements?

Yes No

Does your family have any special dietary requirements?______

  1. To help us best match international students with Homestay families, we require information on the education and occupation of family members.

Name / Education / Occupation / Work Hours
  1. If you are able to take calls at work, could you please provide the business’ telephone number ______
  1. Please give the name and telephone number of 2 local referees who are not related to you ______

Thank you for answering these questions and please return this application form to:

Homestay

Room HA41

International Office

HunterBuilding

University of Newcastle

University Drive

Callaghan NSW 2308

Telephone: 49216777

Or49216774

Email: