Student Application - Happy Homestay Adelaide

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Student Application Form

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

Internet
Friend/Relative
Advertisement
Local School
Current HHA homestay student referral

Current HHA homestay name:

Student’s Information

Family Name *

First Name *

Date of Birth *

Nationality *

Gender *

Male
Female

Please upload your copy of passport *

Click or drag a file to this area to upload.

Mobile *

Email *

Home Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Language you speak *

Religion *

Homestay start date(estimated) *

Homestay end date(estimated) *

Do you smoke? *

Yes
No

Do you have any medical condition/s? *

If yes, please specify: *

Do you have any allergy? *

If yes, please specify: *

Do you have any special dietary requirements? *

If yes, please specify: *

Are you comfortable with pets? *

Please specify which pets you live and which pets you don't live *

Self-introduction *

Parent’s Information

Parents/Guardian 1 - Relation *

Father
Mother
Guardian

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

Father
Mother
Guardian

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

Institution Information

Name of Institution Attending *

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Institution Name *

Institution Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Course Start Date *

Course End Date *

Contact Name: *

Position Title *

Phone *

Email *

Please upload 'Letter of Offer' or 'eCoE' *

Click or drag files to this area to upload. You can upload up to 4 files.

If you will attend more than one institution, please upload every institution's 'Letter of Offer' or 'eCoE'

Have you applied for a visa? *

Yes
No

If yes, has your visa granted? *

Yes
No

Education Agent Information

Name of Education Agency

Contact Name

Phone

Email

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 hereby give Happy Homestay Adelaide permission to collect, use and disclose relevant information about the student for the purpose of the student’s homestay arrangement.
I agree to the Happy Homestay Adelaide Fees and Conditions.

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