Homestay Application Form

Please read our Homestay Host Terms and Conditions prior to completing the form below.

* Required

Title DRMISSMRMRSMS

First Name *

Last Name *

Email Address *

Host Fathers Name

Fathers D.O.B. (dd-mm-yyyy)

Fathers Nationality

Host Mother’s Name

Mothers D.O.B. (dd-mm-yyyy)

Mothers Nationality

Childrens Name 1

Children D.O.B (dd-mm-yyyy)

Childrens Gender -- Please select --MaleFemale

Childrens Name 2

Children D.O.B (dd-mm-yyyy)

Childrens Gender -- Please select --MaleFemale

Childrens Name 3

Children D.O.B (dd-mm-yyyy)

Childrens Gender -- Please select --MaleFemale

Home Address *

City *

State *

Zipcode/Postcode *

Country * -- Select Country --AFGHANISTANALAND ISLANDSALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTARCTICAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA AND HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRITISH INDIAN OCEAN TERRITORYBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPUBLICCHADCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLANDSCOLOMBIACOMOROSCONGOCONGO, THE DEMOCRATIC REPUBLIC OF THECOOK ISLANDSCOSTA RICACÔTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICDENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICECUADOREGYPTEL SALVADOREQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDS (MALVINAS)FAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFRENCH SOUTHERN TERRITORIESGABONGAMBIAGEORGIAGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUERNSEYGUINEAGUINEA-BISSAUGUYANAHAITIHEARD ISLAND AND MCDONALD ISLANDSHOLY SEE (VATICAN CITY STATE)HONDURASHONG KONGHUNGARYICELANDINDIAINDONESIAIRAN, ISLAMIC REPUBLIC OFIRAQIRELANDISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA, DEMOCRATIC PEOPLE'S REPUBLIC OFKOREA, REPUBLIC OFKUWAITKYRGYZSTANLAO PEOPLE'S DEMOCRATIC REPUBLICLATVIALEBANONLESOTHOLIBERIALIBYAN ARAB JAMAHIRIYALIECHTENSTEINLITHUANIALUXEMBOURGMACAOMACEDONIA, THE FORMER YUGOSLAV REPUBLIC OFMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIA, FEDERATED STATES OFMOLDOVA, REPUBLIC OFMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN MARIANA ISLANDSNORWAYOMANPAKISTANPALAUPALESTINIAN TERRITORY, OCCUPIEDPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIARUSSIAN FEDERATIONRWANDASAINT BARTHÉLEMYSAINT HELENASAINT KITTS AND NEVISSAINT LUCIASAINT MARTINSAINT PIERRE AND MIQUELONSAINT VINCENT AND THE GRENADINESSAMOASAN MARINOSAO TOME AND PRINCIPESAUDI ARABIASENEGALSERBIASERBIA AND MONTENEGROSEYCHELLESSIERRA LEONESINGAPORESLOVAKIASLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDSSPAINSRI LANKASUDANSURINAMESVALBARD AND JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIAN ARAB REPUBLICTAIWANTAJIKISTANTANZANIA, UNITED REPUBLIC OFTHAILANDTIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLANDSTUVALUUGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATESUNITED STATES MINOR OUTLYING ISLANDSURUGUAYUZBEKISTANVANUATUVENEZUELAVIETNAMVIRGIN ISLANDS, BRITISHVIRGIN ISLANDS, U.S.WALLIS AND FUTUNAWESTERN SAHARAYEMENZAMBIAZIMBABWE

Home Phone Number *

Work Phone Number *

Cell Phone Number *

Bank Account

Father Occupation

Mother Occupation

Children over 18

Does any member of your family have an existing medical condition that an international student should be made aware of? (e.g. epilepsy) Yes No

If yes, please state which family member and medical condition

Is English the first language spoken at home Yes No

If no, please state your first language

Other languages spoken in the home

Any pets at your home Yes No

If yes, please list any pets and indicate indoor / outdoor

Please write your family’s main religion: (e.g. CATHOLIC)

Do any of the household members smoke? Yes No

Would you host a student who smokes? Yes No

Please list any special dietary restriction (e.g. vegetarian) in your home which may affect students we place with you

Are you able to cater to the requirements of Muslim students? Yes No

General family lifestyle -- Please select --We are a quiet family and prefer mainly staying at home and around the house in our spare time.We are an active family and prefer mainly going out and doing things away from home in our spare time.

Family activities and interests Outdoor sports Indoor sports Music Piano or Guitar etc Language Reading Travel Meeting people Animals Beach Dancing Picnic Gardening Cooking Arts Movies

Do you currently host students from other language School/Providers Yes No

If so, which other school?

Student preferred age?

Student preferred gender Male Female Either

Student Bedroom 1 Single room Double room Twin room

Student Bedroom 2 Single room Double room Twin room

Bathroom Share Bathroom Own Bathroom

Do you provide internet? Yes No

When would you be available to begin hosting student?

We require students to be able to travel directly to downtown without the need to change transport. How will the student travel there?

BUS ROUTE # TO / FROM AUCKLAND CBD:

TRAIN ROUTE # TO / FROM AUCKLAND CBD:

Distance from your home to bus stop / train station

Do you allow us to share your photos on our website? Yes No

If so, will you be able to share photos of your family with us? Yes No

HOW DID YOU HERE ABOUT HOST FAMILIES NZ? -- Please select --InternetSocial Media (i.e FacebookInstagrametc.)Friends / RelativesCollege / EducationEventsMagazinesNewspapersOther

Other