Homestay Application Form

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

* Required

Title DR MISS MR MRS MS

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 -- Male Female

Childrens Name 2

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

Childrens Gender -- Please select -- Male Female

Childrens Name 3

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

Childrens Gender -- Please select -- Male Female

Home Address *

City *

State *

Zipcode/Postcode *

Country * -- Select Country -- AFGHANISTAN ALAND ISLANDS ALBANIA ALGERIA AMERICAN SAMOA ANDORRA ANGOLA ANGUILLA ANTARCTICA ANTIGUA AND BARBUDA ARGENTINA ARMENIA ARUBA AUSTRALIA AUSTRIA AZERBAIJAN BAHAMAS BAHRAIN BANGLADESH BARBADOS BELARUS BELGIUM BELIZE BENIN BERMUDA BHUTAN BOLIVIA BOSNIA AND HERZEGOVINA BOTSWANA BOUVET ISLAND BRAZIL BRITISH INDIAN OCEAN TERRITORY BRUNEI DARUSSALAM BULGARIA BURKINA FASO BURUNDI CAMBODIA CAMEROON CANADA CAPE VERDE CAYMAN ISLANDS CENTRAL AFRICAN REPUBLIC CHAD CHILE CHINA CHRISTMAS ISLAND COCOS (KEELING) ISLANDS COLOMBIA COMOROS CONGO CONGO, THE DEMOCRATIC REPUBLIC OF THE COOK ISLANDS COSTA RICA CÔTE D'IVOIRE CROATIA CUBA CYPRUS CZECH REPUBLIC DENMARK DJIBOUTI DOMINICA DOMINICAN REPUBLIC ECUADOR EGYPT EL SALVADOR EQUATORIAL GUINEA ERITREA ESTONIA ETHIOPIA FALKLAND ISLANDS (MALVINAS) FAROE ISLANDS FIJI FINLAND FRANCE FRENCH GUIANA FRENCH POLYNESIA FRENCH SOUTHERN TERRITORIES GABON GAMBIA GEORGIA GERMANY GHANA GIBRALTAR GREECE GREENLAND GRENADA GUADELOUPE GUAM GUATEMALA GUERNSEY GUINEA GUINEA-BISSAU GUYANA HAITI HEARD ISLAND AND MCDONALD ISLANDS HOLY SEE (VATICAN CITY STATE) HONDURAS HONG KONG HUNGARY ICELAND INDIA INDONESIA IRAN, ISLAMIC REPUBLIC OF IRAQ IRELAND ISRAEL ITALY JAMAICA JAPAN JERSEY JORDAN KAZAKHSTAN KENYA KIRIBATI KOREA, DEMOCRATIC PEOPLE'S REPUBLIC OF KOREA, REPUBLIC OF KUWAIT KYRGYZSTAN LAO PEOPLE'S DEMOCRATIC REPUBLIC LATVIA LEBANON LESOTHO LIBERIA LIBYAN ARAB JAMAHIRIYA LIECHTENSTEIN LITHUANIA LUXEMBOURG MACAO MACEDONIA, THE FORMER YUGOSLAV REPUBLIC OF MADAGASCAR MALAWI MALAYSIA MALDIVES MALI MALTA MARSHALL ISLANDS MARTINIQUE MAURITANIA MAURITIUS MAYOTTE MEXICO MICRONESIA, FEDERATED STATES OF MOLDOVA, REPUBLIC OF MONACO MONGOLIA MONTENEGRO MONTSERRAT MOROCCO MOZAMBIQUE MYANMAR NAMIBIA NAURU NEPAL NETHERLANDS NETHERLANDS ANTILLES NEW CALEDONIA NEW ZEALAND NICARAGUA NIGER NIGERIA NIUE NORFOLK ISLAND NORTHERN MARIANA ISLANDS NORWAY OMAN PAKISTAN PALAU PALESTINIAN TERRITORY, OCCUPIED PANAMA PAPUA NEW GUINEA PARAGUAY PERU PHILIPPINES PITCAIRN POLAND PORTUGAL PUERTO RICO QATAR REUNION ROMANIA RUSSIAN FEDERATION RWANDA SAINT BARTHÉLEMY SAINT HELENA SAINT KITTS AND NEVIS SAINT LUCIA SAINT MARTIN SAINT PIERRE AND MIQUELON SAINT VINCENT AND THE GRENADINES SAMOA SAN MARINO SAO TOME AND PRINCIPE SAUDI ARABIA SENEGAL SERBIA SEYCHELLES SIERRA LEONE SINGAPORE SLOVAKIA SLOVENIA SOLOMON ISLANDS SOMALIA SOUTH AFRICA SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS SPAIN SRI LANKA SUDAN SURINAME SVALBARD AND JAN MAYEN SWAZILAND SWEDEN SWITZERLAND SYRIAN ARAB REPUBLIC TAIWAN TAJIKISTAN TANZANIA, UNITED REPUBLIC OF THAILAND TIMOR-LESTE TOGO TOKELAU TONGA TRINIDAD AND TOBAGO TUNISIA TURKEY TURKMENISTAN TURKS AND CAICOS ISLANDS TUVALU UGANDA UKRAINE UNITED ARAB EMIRATES UNITED KINGDOM UNITED STATES UNITED STATES MINOR OUTLYING ISLANDS URUGUAY UZBEKISTAN VANUATU VENEZUELA VIETNAM VIRGIN ISLANDS, BRITISH VIRGIN ISLANDS, U.S. WALLIS AND FUTUNA WESTERN SAHARA YEMEN ZAMBIA ZIMBABWE

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 -- Internet Social Media (i.e Facebook Instagram etc.) Friends / Relatives College / Education Events Magazines Newspapers Other

Other

Prove you're not a robot *