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Host Family Application

Host Family Application Form

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Homestay Address

Address *

Address Line 1

City

State / Province / Region

Postal Code

Country

Applicant Details

How many carers? *

1
2

Carer 1 Salutation *

Dr
Mr
Mrs
Miss
Ms

First 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)? *

If yes, please provide SRN no.

Expiry date

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.

Carer 2 Salutation *

Dr
Mr
Mrs
Miss
Ms

First Name *

Last Name *

Preferred Name

Date of Birth *

Mobile Phone *

Email *

Occupation *

Religion *

Cultural Background *

Main Language Spoken *

Other Languages Spoken *

Does Carer 2 have valid Working with Children Check (WWCC)? *

If yes, please provide SRN no.

Expiry date

Emergency Contact Details

Salutation *

Dr
Mr
Mrs
Miss
Ms

First Name *

Last Name *

Preferred Name *

Home Phone

Mobile Phone *

Email *

Relationship to Applicant *

People Living in your Home

Number of people living in your home (excluding Carer 1 and Carer 2) *

1

First Name *

Last Name *

Relationship to Applicant *

Gender *

Date of Birth *

Occupation *

If student, please provide school/institution name.

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Expiry date

2

First Name *

Last Name *

Relationship to Applicant *

Gender *

Date of Birth *

Occupation *

If student, please provide school/institution name.

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Expiry date

3

First Name *

Last Name *

Relationship to Applicant *

Gender *

Date of Birth *

Occupation *

If student, please provide school/institution name.

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Expiry date

4

First Name *

Last Name *

Relationship to Applicant *

Gender *

Date of Birth *

Occupation *

If student, please provide school/institution name.

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Expiry date

5

First Name *

Last Name *

Relationship to Applicant *

Gender *

Date of Birth *

Occupation *

If student, please provide school/institution name.

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Expiry date

6

First Name *

Last Name *

Relationship to Applicant *

Gender *

Date of Birth *

Occupation *

If student, please provide school/institution name.

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Expiry date

7

First Name *

Last Name *

Relationship to Applicant *

Gender *

Date of Birth *

Occupation *

If student, please provide school/institution name.

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Expiry date

8

First Name *

Last Name *

Relationship to Applicant *

Gender *

Date of Birth *

Occupation *

If student, please provide school/institution name.

Name of School/Institution *

Valid WWCC *

Yes
No
Under 18

If yes, please provide SRN no.

Expiry date

Accommodation Details

Property Type *

House
Townhouse
Unit
Apartment

Ownership of the property *

Owner Occupied
Rental Property

Numbers of bedrooms in house *

Numbers of bedrooms available for students *

Numbers of bathrooms in house *

Number of bathrooms available for students *

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:

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

How many students do you wish to accomodate? *

Available date for room 1 *

Available date for room 2 *

Available date for room 3 *

Available date for room 4 *

What kind of accommodation can you offer? *

Single Room
Share Room
Both

Please upload Student's Bedroom photo *

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

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.

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.

1. Nationality *

Duration *

Name of School or Tertiary Institution *

Year Level *

2. Nationality *

Duration *

Name of School or Tertiary Institution *

Year Level *

3. Nationality *

Duration *

Name of School or Tertiary Institution *

Year Level *

4. Nationality *

Duration *

Name of School or Tertiary Institution *

Year Level *

5. Nationality *

Duration *

Name of School or Tertiary Institution *

Year Level *

How did you hear about Happy Homestay Adelaide Homestay Program? *

Internet
Friend/Relative
Local School
Current homestay referral (if yes, specify name)

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/We confirm that the information given in this form is true, complete and accurate.
I/We understand the responsibilities and requirements of hosting an international student.
I/We 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/We 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/we approve Happy Homestay Adelaide to collect, hold & work with my personal information/records solely for the purpose of conducting homestay agency duties.

South Australia’s very own Homestay experts professionally matching the needs of international students with Adelaide families since 2003

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We’d love to hear from you

hha@happyhomestay.com.au

hha@happyhomestay
.com.au

+61 8 8276 4476

Po BOX 495, Park Holme,
South Australia 5043

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