Host a Student

Group Name ^*

Program Dates ^*

International Student Name ^*

Family Name ^*

Father's Name

Mother's Name

Street ^*

Suburb ^*

State ^*

Postcode ^*

Phone ^*

Father's Occupation

Mobile Number

Age

Mother's Occupation

Mobile Number

Age

Family Email Address

Name

Age

Gender

Living at home

Interests or Occupation

Do you have any other persons living with the family? If so, please give details:

Will the students have his/her own room? If not, with whom will he/she share?

Do any of your family members smoke?

Do you have any family pets? Please indicate whether they are kept indoors or outdoors.

Please state if there are any special requirements in your family or anything you would like your student to know about:

Do you have a current Police Check? If so, please give details: