New Host Application Test - Happy Homestay Adelaide

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(New)Host Application

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Homestay Address

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Applicant Details

Salutation *

Mr.
Mrs.
Miss
Ms

First Name *

Middle Name

Last Name *

Preferred Name

Date of Birth *

Home Phone

Mobile Phone *

Email *

Occupation *

Religion *

Cultural Background *

Main Language Spoken *

Other Languages Spoken

Do you have valid Working with Children Check (WWCC)? *

Yes
No

If yes, please provide SRN no.

Issued date

Expiry date

Please upload WWCC result

Click or drag a file to this area to upload.

Notes: *

The Department of Human Services (DHS) Screening Unit provides checks of workers and volunteers to organisations, contributing to creating safe environments for children and other vulnerable people.

Emergency Contact Details

Salutation *

Mr.
Mrs.
Miss
Ms

First Name *

Last Name *

Preferred Name *

Mobile Phone *

Email *

Relationship to Applicant *

Resident(s) Information

Number of Resident in your home (excluding Applicant) *

Resident 1

First Name *

Middle Name

Last Name *

Relationship to Applicant *

Gender *

Male
Female

Date of Birth *

Email *

Mobile Phone *

Occupation *

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Issued date

Expiry date

Please upload WWCC result

Click or drag a file to this area to upload.

Resident 2

First Name *

Middle Name

Last Name *

Relationship to Applicant *

Gender *

Male
Female

Date of Birth *

Email *

Mobile Phone *

Occupation *

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Issued date

Expiry date

Please upload WWCC result

Click or drag a file to this area to upload.

Resident 3

First Name *

Middle Name

Last Name *

Relationship to Applicant *

Gender *

Male
Female

Date of Birth *

Email *

Mobile Phone *

Occupation *

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Issued date

Expiry date

Please upload WWCC result

Click or drag a file to this area to upload.

Resident 4

First Name *

Middle Name

Last Name *

Relationship to Applicant *

Gender *

Male
Female

Date of Birth *

Email *

Mobile Phone *

Occupation *

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Issued date

Expiry date

Please upload WWCC result

Click or drag a file to this area to upload.

Resident 5

First Name *

Middle Name

Last Name *

Relationship to Applicant *

Gender *

Male
Female

Date of Birth *

Email *

Mobile Phone *

Occupation *

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Issued date

Expiry date

Please upload WWCC result

Click or drag a file to this area to upload.

Resident 6

First Name *

Middle Name

Last Name *

Relationship to Applicant *

Gender *

Male
Female

Date of Birth *

Email *

Mobile Phone *

Occupation *

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Issued date

Expiry date

Please upload WWCC result

Click or drag a file to this area to upload.

Accommodation Details

Property Type *

House
Townhouse
Unit
Apartment

Ownership of the property *

Owner Occupied
Rental Property

Number of bedrooms in house *

Number of bathrooms in house *

Number of bedrooms for students *

Room 1

Bed Type for Room 1 *

Bathroom type for Room 1 *

Room 1 Availability *

Available date for room 1 *

Please upload photos of Room 1 *

Click or drag files to this area to upload. You can upload up to 3 files.

Room 2

Bed Type for Room 2 *

Bathroom Type for Room 2 *

Room 2 Availability *

Available date for room 2 *

Please upload photos of Room 2 *

Click or drag files to this area to upload. You can upload up to 3 files.

Room 3

Bed Type for Room 3 *

Bathroom Type for Room 3 *

Room 3 Availability *

Available date for room 3 *

Please upload photos of Room 3 *

Click or drag files to this area to upload. You can upload up to 3 files.

Room 4

Bed Type for Room 4 *

Bathroom Type for Room 4 *

Room 4 Availability *

Available date for room 4 *

Please upload photos of Room 4 *

Click or drag files to this area to upload. You can upload up to 3 files.

Does your family have special dietary preference? *

If yes, please specify: *

Do you have Pet? *

If yes, please specify (inside, outside and type) *

Please upload pet(s) photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Does anyone in the house smoke? *

Family interests, hobbies and activities: *

Additional information:

Photos of house

Please upload Student's Bathroom photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload Living Area photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload Dining Area photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload Front of House photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Please upload Outdoor photo *

Click or drag files to this area to upload. You can upload up to 3 files.

Hosting Preference

Gender *

Male
Female
No Preference

Age Group *

10 to 14
10 to 18
15 to 18
Over 15
Over 18
No Preference

Duration *

Short-term (up to 14 days)
1 to 3 months
At least a month
Up to 3 months
3 months and longer
No Preference

Would you accept a student with special dietary restriction? *

If yes, please specify: *

Would you accept a student who smoke in your house? *

Yes
Yes - outside only
No

Any additional you would like to add?

Homestay Experience

Are you currently listed to host International students with any other agencies / education provider? *

If yes, please specify: *

Have you hosted any International students in last 2 years? *

If yes, please provide details.

Student 1

1. Nationality *

Gender *

Duration *

Name of School or Tertiary Institution *

Year Level *

Student 2

2. Nationality *

Gender *

Duration *

Name of School or Tertiary Institution *

Year Level *

Student 3

3. Nationality *

Gender *

Duration *

Name of School or Tertiary Institution *

Year Level *

Student 4

4. Nationality *

Gender *

Duration *

Name of School or Tertiary Institution *

Year Level *

How to know Happy Homestay Adelaide Homestay Program *

Internet
Local School
Referral

Single Line Text *

Referees

Please provide 2 referees for reference check:

1. Full Name *

Relationship to applicant *

Contact Number *

2. Full Name *

Relationship to applicant *

Contact Number *

Declaration

Declaration: *

I confirm that the information given in this form is true, complete and accurate.
I understand the responsibilities and requirements of hosting an international student.
I understand that in order to host an International Student:
*** A satisfactory DHS Screening working with children check is required for all persons over the age of 18 residing in the home.
I understand that Happy Homestay Adelaide attempts to select genuine students and cannot be held responsible for any undesirable or negligent actions of the student.
I approve Happy Homestay Adelaide to collect, hold & work with my personal information/records solely for the purpose of conducting homestay agency duties.

info@happyhomestay.com.au
Tel: +61 8 8276 4476

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