Welcome - Homestay Application Form

South Australian Government Schools - Homestay Application Form

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AUTOFILL FORM TEXT INPUTS

Nominated Homestays only:

If you are applying to host a specific student please provide their full name and date of birth:

Family Name

Given Name(s)

Date of Birth

Would you be interested in hosting other international students in our program in the future?

1. People Living in your Home

Please list all persons residing in your home including family members, other international students and those who stay overnight on a temporary basis.

Family Name First Name Middle Name(s) Relationship to
Homestay Applicant		 Gender Date of Birth Occupation and working hours or school attending Current Working with Children Check

Add more people ..

2. Contact Details

Address line *

Suburb *

Postcode *

Postal address

Home telephone

Mobile 1 - Applicant *

Mobile 2

Email 1 - Applicant *

Email 2

3. Secondary / Emergency Contact Details

Please provide details of someone who doesn’t live in your home we can contact in case of an emergency if we can’t contact you. It is important that this person has reasonable English proficiency. This person should also be available to attend the homestay visit if the main applicant has limited English.

Name *

Relationship to Homestay Applicant *

Address *

Contact phone number/s *

Email *

4. Fill-in Homestay Details

Please provide details of someone aged 25 years or older, who could stay in your home and care for the international student(s) in your absence (planned holiday / emergency). We will arrange a Working with Children Check for your fill-in homestay. Please ensure your nominated person is aware you have provided us with their details.

Name

Gender

Address

Contact phone number

Email

Date of Birth

5. Your Student Preference (not required if you are applying to host a particular student)

Gender *

Duration *
(tick all that apply)

Nationality *

Age Group *

How many students can you accommodate in single bedrooms? *

Which types of dietary needs are you able to cater for?
(tick all that apply)

Would you consider hosting a student with additional needs? *
(eg allergies, asthma, epilepsy)

Emergency Accommodation
From time to time our office requires homestays at short notice to accept students for a variety of reasons. The call to take a student in an emergency situation most often happens after hours, and occasionally in the middle of the night.

Would you be willing to accept a student in an emergency situation (temporarily or permanently)? *

6. About Your Family

What is your family cultural background? *

Does your family have any religious affiliation? *

Do you attend a regular service? *

What is the main language spoken at home? *
(please note that homestays are expected to speak English with their students)

What other languages are spoken at home?

Does your family have pets? *

Does anyone in the home smoke? *

Please write a brief description of your family *
activities, lifestyle etc. (This may be used in the profile provided to new students). 100 words maximum.

7. Prior Homestay Experience

Are you currently listed to host international students with any other organisation/s? *

Have you hosted international students in the last 2 years? *

8. Homestay who referred you to the Homestay program (if applicable)

Family name

Given name

Why did this Homestay recommend the Homestay program to you?

9. How did you hear about the South Australian Government Schools Homestay program? *

10. Why are you interested in becoming a Homestay? *

Choose more than one option if applicable

11. Photo Upload

These photos will be provided to agents and new students as part of your homestay profile. Please ensure rooms are neat and tidy. Please upload the following photos:

  • Recent family photo
  • Front of the home
  • Student bedroom(s)
  • Student bathroom
  • Main living areas – kitchen, dining, lounge
  • Outdoor area
  • Pets (if applicable)

Uploaded photos

Please allow time for your photos to upload. If your photos do not upload, please email them to [email protected]

    Total: 0 photos uploaded.

    12. Homestay Declaration