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Student Application

Student Application Form

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

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

Current HHA homestay name:

Student’s Information

Salutation *

Dr
Mr
Mrs
Miss
Ms

Family Name *

First Name *

Date of Birth *

Nationality *

Mobile *

Email *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Language you speak *

Religion *

Length of Homestay required *

From

Length of Homestay required *

To

Do you smoke? *

Yes
No

Do you suffer from any medical condition/s? *

If yes, please specify: *

Do you suffer from any allergy? *

If yes, please specify: *

Do you have any special dietary requirements? *

If yes, please specify: *

Are you comfortable with pets? *

If only some, please state (e.g: Cat): *

What are your hobbies/interests? *

Parent’s Information

Parents/Guardian 1 *

Dr
Mr
Mrs
Miss
Ms

Family Name *

First Name *

Nationality *

Occupation *

Mobile *

Email *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Parents/Guardian 2

Dr
Mr
Mrs
Miss
Ms

Family Name

First Name

Nationality

Occupation

Mobile

Email

Home Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Emergency Contact

Relationship to student: *

Family Name *

First Name *

Nationality *

Occupation *

Mobile *

Email *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

School Information

Name of School Attending *

School Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Start Date *

Duration *

Contact Name: *

Position Title *

Phone *

Email *

Education Agent Information

Name of Education Agency

Contact Name

Phone

Email

Additional Information

Additional Information

Declaration:

Declaration of Happy Homestay Adelaide Fees and Conditions: *

I confirm that the information given in this form is true, complete, and accurate.
I agree to the Happy Homestay Adelaide Fees and Conditions.

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

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Contact

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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