GENERAL STUDENT HOMESTAY APPLICATION FORM

Name of Agent:
E-mail address of Agent :
Name of Agent's Contact person
Students details
Family name:
Given name:
Date Of Birth:
Age:
Gender:
Nationality :
E-mail address :
Do you smoke:
Date of Arrival:
Time of Arrival:
Flight Number :
School you will attend
( Please state which campus &
course you shall study?:
Do you require transport
from the airport to the homestay?:
( THIS FEE IS $110.00 )
Do you have any food Allergies
or dietary requirments?
Detals:
Any Medical Details we need to know about?:
HOMESTAY INFORMATION
What date do you require
homestay from? MINIMUM STAY 2 WEEKS
UNLESS PRIOR ARRANGEMENT :*
Please note you will be placed in the best homestay available at the time of your application.
Smoking
Other students
Other Children
Pets
Message:

All payments made via electronic banking or by telegraphic transfer should note the name of the student as the reference. You will be sent an invoice for the placement fee of $200 plus the first two weeks accommodation costs of $630 ($315 per week including internet). Total payment $830.00
Bank Transfer or Bank Cheque
Westpac Bank - Ivanhoe Branch (216 Upper Heidelberg Road)
BSB No: 033057 Account No: 234861
Account Name: Student Accommodation Services Pty Ltd
SWIFT CODE: WPAC AU 2S

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