寄宿家庭申请表 寄宿家庭申请表 Student Homestay Application Form Step 1 of 3 33% 姓名 / 团队 (如有) Name/Group (if applicable)性别 GenderMale Female姓名 Name* 名 First 姓 Last 出生日期 Date of BirthDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920住址 (国内) Address (Home Country) 街 Street 街 Street 城市 City 州/省 State / Province 邮编/邮政编码 Zip / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands 国家 Country 邮箱地址 Email 联系电话 Phone入住寄宿家庭日期 Commencement Date of Homestay日 Day日 Day12345678910111213141516171819202122232425262728293031月 Month月 Month123456789101112年 Year年 Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920寄宿家庭长度 Length of HomestayPlease enter a number from 0 to 52.(周) (in weeks) 您有几位家庭成员? How many other members in your family?*123456家庭成员资料1 Family Member 1 Details名字 Given Names 名 First 姓 Last 年龄 AgePlease enter a number from 0 to 100.关系 Relationship父亲 Father母亲 Mother兄弟 Brother姐妹 Sister职业 Occupation家庭成员资料2 Family Member 2 Details名字 Given Names 名 First 姓 Last 年龄 AgePlease enter a number from 0 to 100.关系 Relationship父亲 Father母亲 Mother兄弟 Brother姐妹 Sister职业 OccupationOther家庭成员资料3 Family Member 3 Details名字 Given Names 名 First 姓 Last 年龄 AgePlease enter a number from 0 to 100.关系 Relationship父亲 Father母亲 Mother兄弟 Brother姐妹 Sister职业 OccupationOther家庭成员资料4 Family Member 4 Details名字 Given Names 名 First 姓 Last 年龄 AgePlease enter a number from 0 to 100.关系 Relationship父亲 Father母亲 Mother兄弟 Brother姐妹 Sister职业 OccupationOther家庭成员资料5 Family Member 5 Details名字 Given Names 名 First 姓 Last 年龄 AgePlease enter a number from 0 to 100.关系 Relationship父亲 Father母亲 Mother兄弟 Brother姐妹 Sister职业 OccupationOther家庭成员资料6 Family Member 6 Details名字 Given Names 名 First 姓 Last 年龄 AgePlease enter a number from 0 to 100.关系 Relationship父亲 Father母亲 Mother兄弟 Brother姐妹 Sister职业 OccupationOther 关于自己 About You爱好和兴趣? Hobbies and interests? 橄榄球 Rugby 棒球 Baseball 冲浪 Surfing 美术 Art 摄影 Photography 阅读 Reading 看电影 Watching Movies 游泳 Swimming 有氧运动 Aerobics 听音乐 Listening to music 网球 Tennis 帆船 Sailing 爬山 Hiking 舞蹈 Dancing 潜水 Scuba Diving 高尔夫球 Golf 篮球 Basketball 钓鱼 Fishing 足球 Soccer 武术 Martial Arts 旅游 Travel 烹饪 Cooking 弹奏乐器 Playing Musical Instruments 您怎么形容您的英语口语水平? How would you describe your English speaking ability?非常好 Very Good好 Good普通 Fair弱 Poor您喜欢有小孩的寄宿家庭吗? Would you prefer a family with children? 喜欢 Yes 不喜欢 No 都可以 Don't Mind 您讨厌有宠物的家庭吗? Do you have any objection to pets? 是 Yes 否 No 您吸烟吗 Do you smoke? 否 No 是 Yes 是,但我会在室外吸烟 Yes, but I will smoke outside 大多数的澳洲寄宿家庭不允许室内吸烟 Most Australian families do not allow smoking inside 您喝酒吗? Do you drink alcohol? 是 Yes 否 No 您有任何食物过敏吗? Are you allergic to any food? No 如有，请详细列出 Please specify您有不喜欢的食物吗? Do you have any food dislikes?您有任何健康状况吗 ?Do you have any health problems? No Yes 请详细列出 Please specify您有服用任何药物吗? Do you take any medication? 沒有 No 有 Yes Please specify 请详细列出您喜欢动物吗? Do you like animals? 喜欢 Yes 不喜欢 No 您喜欢什么动物? Which animals do you like? 鳥 Bird 貓 Cat 狗 Dog 魚 Fish 您会怎么形容您自己? How would you describe yourself? 善于交际 sociable 乐观 positive 合群 co-operative 高成就者 high achiever 害羞 shy 好奇 curious 开朗 cheerful 情绪化 emotional 热情 affectionate 紧张 nervous 安静 quiet 严肃 serious 您有曾离开家生活过吗? Have you ever lived away from home before? 有 Yes 没有 No CAPTCHA Δ
