Application forms for accommodation in Brisbane

student application
host family application
additional documents for family application

Brisbane Student Application

Please complete all fields and submit this application form.

Emergency Contact Details
Person in Australia
Name	Telephone
Email	Address
Overseas Parent or Guardian*
Name* Please enter the name of your parent or guardian overseas	Telephone* Please enter the phone number of your parent or guardian overseas
Email* Please enter the email of your parent or guardian overseas	Address* Please enter the address of your parent or guardian overseas
* I agree to abide by Australia’s Anti-Discrimination Law http://www.lawlink.nsw.gov.au/adb and Privacy Law http://www.privacy.gov.au Please accept these conditions * I have read and agree to the Aussie Families Tariffs, Terms and Conditions on http: www.auzziefamilies.com Please accept these conditions

Payment Options

printer Click here for a print version

1. TELEGRAPHIC TRANSFER payable to AUZZIE FAMILIES Homestay Care Pty Ltd No2 A/C (Bank details upon application)

2. BANK DRAFT Payable to AUZZIE FAMILIES Homestay Care Pty Ltd No 2 A/C

3. TELEPHONE61 2 9301 0900 and quote your credit card details MasterCard / Bankcard / Visa

4. DIRECT CREDIT CARD CHARGE fill out the authority below and return it to our address (Note a 4.5% surcharge applies to all credit card transactions. Please add this amount to your total payment.)
CARD NUMBER................................................................................................
TYPE OF CARD MasterCard.........BANKCARD........VISA...................

SIGNATURE.....................................

NAME ON CARD..................................
EXPIRY DATE..................................

AMOUNT $..........................................

5. CHEQUE payable to AUZZIE FAMILIES Homestay Care Pty Ltd

Please print this page and fax to 61 2 9301 0999 or post to
AUZZIE FAMILIES Homestay Care Pty Ltd
PO Box 112 Rose Bay NSW 2029 Australia

Given Name		Family Name
Your Nationality*	Please enter your nationality	Date of Birth*	Please enter your birth date
Your Gender*	Male Female Please select your gender
Street Address		City
Country		Area / Zip / Post Code
Phone Number:		Fax :
Email :
Agency Name:		Agency Branch:
Counsellor's Name:		Counsellor's Email:
Do you smoke?	yes no	Will you live with a smoker?	yes no
Do you like young children?	yes no	Do you like older children?	yes no
Do you like animals?	yes no	Are you allergic to Animals?	yes no
Do you have any special dietry requirements?		Religion (optional)
Do you have any illness?
Name of Educational Institution in Australia*		Please enter your educational institition
Education Institution: Campus Name / Location or Campus Address
Course Commencement Date*		Please enter your course commencement date
Accommodation required from (date) to
Is an airport pick up required?* Yes No Please select if you require airport pickup		Flight No. Airline Time of Arrival
Tell me about yourself, your family and your interests
What kind of family would make you feel comfortable?
Type of accommodation required