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 4 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.
Placement fee of $150 and the first four weeks accommodation costs of $1100 ($275 per week) should accompany this request - total payment $AUD1250 If airport pickup is required please add an additional $AUD110
Note: $30 fee applies for International bank transfer only. Please add this amount to the total payment if using this method of payment.
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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