GENERAL STUDENT HOMESTAY APPLICATION FORM

* Required Field

Name of Agent :*
E-mail address of Agent :*
Name of Agent's Contact person :*

STUDENT'S DETAILS -

Family name :*
Given name :*
Date Of Birth :*
Age :*

Male / Female :*
Nationality :*
E-mail address:*
Do You Smoke:*
Date of Arrival:*
Time of arrival :*

Flight Number :*
School you will attend ( Please state which campus & course you shall study? :*

Do you require transport from the airport to the homestay?:* ( THIS FEE IS $95.00 )
Do you have any food Allergies or dietary requirments? :* Detals :*
Any Medical Details we need to know about? :*
HOMESTAY INFORMATION -

What date do you require homestay from? MINIMUM STAY 4 WEEKS UNLESS PRIOR ARRANGEMENT :*

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

Smoking :*
Other students :*
Other children :*
Pets:*

Over 65% of Australian homestays have a registered dog or cat you LIMIT your options by requesting No pets.

Message:

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

Placement fee of $150 and the first Four weeks accommodation costs of $ 1000 should accompany this request. TOTAL PAYMENT = $ 1150 (Australian $$$’s) PLUS ADD $95 (Australian $$$’s) IF YOU NEED TRANSPORT TO YOUR HOMESTAY.

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

Bank Transfer or Bank Cheque

Westpac Bank - Ivanhoe Branch (216 Upper Heidelberg Road)

BSB No: 033057 Account No: 234861

Account Name: Student Accommodation Services Pty Ltd

SWIFT CODE: WPAC AU 2S

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Student/Parent Credit Card details for Payment (if applicable):

Card No.

Expiry Date:/

CCV ( Last 3 digits on back of card )

Name on Card:

Disclaimer:

Student Accommodation Services is NOT liable for any credit card details supplied via the internet.

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