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Test
Primary Applicant
Full Name
*
First Name
Last Name
Date of Birth
*
DD slash MM slash YYYY
Occupation
*
Employer
Home Phone
Mobile Phone
*
Business Phone
Email
*
Family Details
Is there a secondary applicant?
*
Yes
No
Full Name
*
First Name
Last Name
Date of Birth
*
DD slash MM slash YYYY
Occupation
*
Employer
Home Phone
Mobile Phone
*
Business Phone
Email
*
Home Address
Address
*
Street Address
Address Line 2
City
Postcode
Do you:
*
Own
Rent
Other
Easiest way for student to travel to Sancta Maria College
*
Walk
School Bus
Drive
Public Transport
Other
Approximate travel time this would take
*
i.e. 5 minute walk
General Information
What is the main language spoken at home?
*
Religion:
Do you regularly attend church?
Yes
No
Do you observe any specific dietary customs?
Please detail
Family Interests & Hobbies
*
Does anyone in the family smoke
*
Yes
No
Do you have any pets?
*
Yes
No
If yes, please list pets
Do you agree to undergo police vetting as per the Homestay legislation requirements?
*
Yes
No
Children
Do you have children?
*
Yes
No
Child One
Full Name
*
First Name
Last Name
Date of Birth
*
DD slash MM slash YYYY
Gender
*
Male
Female
Child Two
Full Name
First Name
Last Name
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Child Three
Full Name
First Name
Last Name
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Accomodation Details
Each room must have a single or double bed, wardrobe, drawers and adequate lighting. The desk, chair and lamp can be located in a separate area.
About your home
*
Single Storey
House
Two Storey
Apartment
Number of bedrooms
*
Number of bathrooms
*
How many rooms do you have available for International Students?
*
Will the student have:
Own Bathroom and Toilet
Shared Bathroom and Toilet
Will the student have:
Desk for Study and Study Lamp
No desk for study
Do you have installed working smoke alarms?
*
Yes
No
Do you have a First Aid Kit?
*
Yes
No
Student Preference
Gender
*
Male
Female
Either
Duration
*
Long term
Short term
Either
Additional Comments:
Please list any other details relevant to your application
Emergency Contact
(A contact outside your immediate family)
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Address
*
Street Address
Address Line 2
Postcode
Emergency Contact Home Phone
Emergency Contact Mobile Phone
*
Emergency Contact Email
*
Referees
(Please include people who have known you and your family for more than 12 months)
Referee One Name
*
Referee One Email
*
Referee Two Name
*
Referee Two Email
*
TERMS & CONDITIONS
Thank you for offering a homestay for an International Student attending Sancta Maria College. If you accept a student for homestay, then the terms and conditions upon which the homestay is to be provided by you shall be set out in the Residential Caregiver Agreement and will continue to apply for homestays arranged through Sancta Maria College. Any amendments or variations to the ‘Residential Caregiver Agreement’ shall only have effect as notified to you in writing by Sancta Maria College. In addition, for any changes relating to a move of a student from your home due to any un-notifiable change whereby the student must move, the notice period may not apply.
Acceptance of Terms
I acknowledge that the above information is true and correct and that I have read and understood the ‘Residential Caregiver Agreement’. I consent to Sancta Maria College International Department sharing my contact details with other host families.
I/We hereby acknowledge and agree to the 'Residential Caregiver Agreement'
*
I/We Agree
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