Deakin Application

Name of Agent

Email address of Agent

Name of Agent's Contact person

Family name

Given name

Date Of Birth

Age

Gender

Nationality

What Provence/City do you reside in

Student Email address

Parent Email address (Required for invoicing purposes)

Caregiver Company

Do you smoke:
YesNo

Date of Arrival

Time of Arrival

Flight Number

Do you require transport from the airport to the homestay? (Compulsory for students under 18)
YesNo

Homestay Start Date

How many weeks do you require homestay? (4 weeks is the minimum stay)

What area of Deakin do you commence your studies?

Deakin Campus

Course Start Date

Do you have any food allergies and/or dietary requirements? Details:
Please list your Food Allergies and/or Dietary Requirements here.

Any Medical Details we need to know about?
Please list your Medical details here.

Please note you will be placed in the best homestay available at the time of your application

Smoking (Outside Only)
YesNo

Other students
YesNoDon't Mind

Other Children
YesNoDon't Mind

Pets
YesNoDon't Mind

Message

All payments made via electronic banking or by telegraphic transfer should note
the name of the student as the reference.

You will receive an invoice for the placement fee and the first four weeks
accommodation shortly. Payment details will be on the invoice.

Note: $30 fee applies for International bank transfer only. Please add this amount
to the total payment if using this method of payment.