Homestay Application Form

Please complete the application below and we'll find the right homestay for you.

First name: Last Name: Gender: Please Select... Female Male Nationality: Date of Birth: (dd/mm/yyyy) Ex: 19/01/1987 Email Address: Telephone: Country-Area-Number: Fax: Country-Area-Number: Home Country Address Street: City: State, Province or Prefecture: Postal/Zip Code: Country: Emergency Contact Person Name & Contact Number: Homestay Particulars Arrival Date: (dd/mm/yyyy): Ex: 24/11/2008 Departure Date: (dd/mm/yyyy): Ex: 24/11/2009 Visa Type: Please select... Student Tourist Working holiday Other Airport Pickup Required? Please select... Yes No Flight Arline and Number: Arrival Time: Purpose of Visit Educational Working Holiday HomeStay Only Cultural Tour Other English Level: Please select... Beginner Pre-Intermediate Intermediate Upper-Intermediate Advanced Do you smoke? Yes No Are pets okay in the home? Yes No Will you live with: Please select... Young Children Older Children No Children Don't Care Do you have any food, pet or other allergies? Yes No If yes, please explain: What are your hobbies/interests? Please tell us about any special dietary requirements. (For example Are you a vegetarian?) Is there any food you don't eat? Is there anything else you would like us to know? Would you like to participate in our support program? Please select... Yes No Tell me more

BEST Australia respects the privacy of your personal information and is committed to ensuring its proper collection, storage, use and disclosure. Under no circumstances will information be sold or made available to marketing agencies or similar parties who are not involved with BEST Australia.