Select one House Semi/Terrace Flat/Unit *
Other (please specify)
Are there any smokers in the house? Yes No *
Do you allow smoking in your home? Yes No Outside only *
Do you have any pets? Yes No *
If yes, please specify
Do they in, or outside the home? Inside Outside
Please list pastimes and interests of family members *
Age range
Gender Male Female
Other student preferences
Reasons for preferences?
Meal preferences Home Stay with meals provided Home Stay without meals provided *
What is your religion?
Do you have a preference for a student of a certain religion?
Are you able to accommodate students with special dietary requirements? Yes No *
If yes, please provide details
Do you have any special dietary requirements? Yes No *
Are you able to accommodate students with asthma, hay fever or other allergies? Yes No *
Are you able to accommodate students with disabilities? Yes No *
If yes, please give details
Are you able to accommodate students in wheelchairs? Yes No *
Please select the entertainment facilities that are available to students at your home Computer Internet access Swimming pool Tennis court Piano Video player CD player DVD player Games room
Name
Date of birth
Relationship
Occupation/education
Have you hosted international students in the past? Yes No *
Bank name
Account name
BSB
Account number
Security
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