ONLINE FORMS - Homestay Profile Form

ONLINE FORMS

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HOMESTAY PROFILE FORM

PLEASE COMPLETE THE FOLLOWING:
PERSONAL DETAILS
Program Name
Dates of Program
Surname
Given Names
Date of Birth	(DD/MM/YYYY)
Age
Place of Birth
Nationality
Religion
Sex	Female Male
ADDRESS IN HOME COUNTRY
Address
Phone
Email
ACADEMIC LEVEL
Current Studies
Year
What is your level of English?	Beginner Elementary Intermediate Advanced
Other Languages
OTHER DETAILS
Do you smoke? (If Yes, you may still be placed in a non-smoking home)	Yes No If Yes, How Much?
Do you like children?	Yes No
Do you like pets, such as Dogs and Cats?	Yes No Other
Do you have any Allergies?	Yes No If Yes, Please name Allergies
Do you have any special dietary requirements?	Yes No If Yes, Please provide details
AIRPORT PICKUP
Do you require an airport pickup on arrival?	Yes No
Date of Arrival	(DD/MM/YYYY)
Flight Number
Flight Arrival Time
HOMESTAY BOOKING
Number of weeks
Date of Arrival	(DD/MM/YYYY)
Date of Departure	(DD/MM/YYYY)
AREAS OF INTEREST
Please list the hobbies/interests and activities you enjoy? (ie. athletics, cultural, academic)
Briefly describe your family and include something special about yourself and your interests which will help your host family to know you better
I agree	I have read and I understand the refund/cancellation policy. I agree to abide by the regulations of The University of Queensland.

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