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STUDENT APPLICATION – Auzzie Families Homestay Care

STUDENT APPLICATION - Auzzie Families Homestay Care

Student Application

Please fill out the form below, providing as much detail as possible.

Location *

Student Details

First Name *

Surname *

Preferred Name

Gender *

Status

Date of Birth *

Nationality *

Main Languages Spoken *

Student Contact Details

Email Address *

Mobile Phone Number *

Facebook

Wechat

Agent Contact Details

Agent Business Name *

Branch / Office

Counsellor's Name *

Email Address *

Office Phone Number *

Mobile Phone Number *

Course Details

Course Name *

Address/Campus Location *

Course Start Date *

Course Length In Weeks

Arrival Details (if known) & Accomodation Requirements

Flight Arrival Date

Arrival Time

Flight No.

Require Airport Pick-up *

Accomodation Start Date

Accomodation End Date

Type of Accomodation Required

Student Personal Details

Religion

Do you have any medical conditions? *

Mobility Issues
Eating Difficulties
Asthma
Depression/Anxiet
Eplilepsy
HIV or Aids
Others

Give Details If Other Medical conditions

Do you have any allergies? *

Food Allergy
Bee/Wasp Allergy
Dust/Dust mites
Others

Give Details If Others

Do you need a special diet? *

Vegan
Kosher
Halal
Vegetarian
Gluten free
No Pork

Do you currently take medication? *

Details

Do you smoke? *

Details

Any special requests?

Hobbies or Interests
Sports
Reading
Beach
Computer Gaming
Outdoors
Dancing
Watching TV and Movies
Outing with friends
Shopping
Gym

Any other information you would like to tell us about yourself

Documents Upload

Passport

Your Photo

Size 250X200 Pixels

Visa

Others

Declaration

Student requests are seriously considered but it may not be possible to meet all requests. Additional requests cannot be considered after placement confirmation or additional charges apply.

Do you agree to abide by Australia's Anti-Discrimination Law and Privacy Law?

I agree to abide by the Anti-Discrimination Law

I agree to abide by the Privacy Law

Have you read and agreed to the Auzzie Families Homestay Care Terms and Conditions?

I agree to the Auzzie Families Homestay Care Terms and Conditions

Please include an email address to send confirmation of this form submission *

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Address
PO Box 1219 Eastwood NSW 2122 Australia
Phone
+61 2 8328 8499
Mobile
+61 419 125 822
Email
info@auzziefamilies.com

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