Application Form

Homestay Application Form :

It is important that you answer all of the questions below if you want us to find a good 'Kiwi' Homestay for you to live.

If you do not understand any of our questions, then simply tell us the question number eg.7) or 24) in the space below under: Question 41) 'Any questions'.

1) Please help me to find a Homestay , Flat , Room only ( no meals ) .
2) 'Kiwi' (English) Name
3) First name
4) Last ( family ) name
5) Home country Address
6) New Zealand Address
7) Nationality
8) Home Phone
9) Mobile Phone
10) E-mail
11) Passport Number
Male Female	12) Date of Birth:
13) How long have you been in NZ:
14) Emergency Contact:
Please provide the name, address and telephone number of TWO people we can contact in case of an emergency:
Person number 1: NAME: ADDRESS: TELEPHONE NUMBER: Person number 2: NAME: ADDRESS: TELEPHONE NUMBER:
15) What is the name of your school:
16) What is the address of your school:
17) Are you looking for a new school ? Yes No
18) What time does your school start each day ? Start - Finish:
19) What is your English level ? Poor So so Good Very Good
20) Have you sat your IELTS exam ? Yes No
If Yes, what was your mark ?
21) What suburb would you like us to find you a flat / homestay / room ?
Please give us a choice of suburbs: ( eg, Takapuna, Mt Roskill, etc )
22) If you like your new homestay, maybe how long would you like to stay ?
23) Do you have a computer ? Yes No If Yes, is it a Desktop or Notebook ?
24) If Yes, do you want to go on the internet ? Yes No
25) If Yes, how many hours do you want to spend on the internet each day ?
Note: Some students want to stay on the internet for several hours every day “chatting” to their friends or playing games. Others only want to go ‘on-line’ for 30 minutes to check their Emails. Some Homestays may agree to let students use the Homestay’s telephone line ( for internet ) for 1 – 2 hours late at night. Very few Homestays have ADSL so sometimes there is a problem with students wanting to spend too much time on the internet / telephone talking to their friends. If a student wants to be on the telephone / internet for more than 1 – 2 hours each day, then usually a student must pay for their own telephone line. The cost every month for your own telephone line rental is about $39.90 every month. Most students who want to stay on the telephone ( internet ) line for serious study tell us they are happy to pay for their own line, so if the Homestay has a second line, there is not a problem. If you really need the internet to “study” for assignments, then you will need your own line. Note: Some students ask if they can use the Homestay’s computer to go on the internet. The usual answer is: “sorry, but No”.
26) Do you want to pay for your own telephone line / rental ? Yes No
27) Do you own a car ? Yes No If No, will you buy a car later ? Yes No If Yes, when will you buy a car ?
28) Do you smoke ? Yes No
29) Many 'Kiwi' families keep friendly pets. Their children love to play with their pet animals. Do you like friendly pets ? Yes No Cats: Yes No , or Dogs: Yes No
30) If there is another overseas student in the Homestay is that a problem for you ? Yes No Maybe If Yes, which nationality student don`t you like:
31) Do you like children ? Yes No Comments: Pls describe:
32) What are your interests ? ( example: Basketball, Fishing, Music, etc ) Pls describe your interests: eg:I like fishing,soccer,basketball.
33) Would you like to join our Sports, Social and Travel club 'Club Asianz' ? Yes No If Yes, please complete the: APPLICATION FORM FOR “Club Asianz” MEMBERSHIP:

Homestay Fees:
We ask our Homestays 'How much is your fee?'
We try to find the best price for Homestay fee for you, however the higher the Homestay fee usually the quality is better and the Homestay is closer to the city.
Note: If you are not prepared to pay a reasonable fee, then maybe we can not help you ? Please do not ask for 'five star' accommodation at 'Backpacker' hostel prices.
34) Note: Minumum ' Homestay' fees: From $ 180.00 ( Mon - Friday: 2 meals) ( Sat - Sunday: 2 - 3 meals )
Minumum 'Room Only' ( No meals ) fee: From $ 130.00 per week.
What is the maximum you can pay for Homestay fee:
No more than per week.
35) If we can find you a good Homestay, when would you like to move into our new Homestay ?
I would like to move on:
36) Do you have any allergies or medical problems ? Yes No If Yes, what are they ?
37) Is there any kinds of food you can not eat ? Yes No
If Yes, please describe:
38) Any other dislikes ?
39) What is the name, address and phone number of your Agent ? Just for New Zealand Agent; Name: Address: Phone number:
40) Are you under 18 years of age, if so you must have a Guardian. What is your Guardian`s name, address and phone number ? Your Guardian`s Name: Address: Phone number:
41) Do you have any questions ? Any questions:
42) How did you learn about our service ? Friend , School , Newspaper , Agent , Internet , Other

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