Homestay Application Form – Formulário de Aplicação para Estadia em Casa de Família Student Homestay Application Form - Portuguese Δ Step 1 of 3 33% IMPORTANT NOTICE: Conditions apply to homestay placement. The conditions are detailed at the end of this form. I ACKNOWLEDGE that by proceeding to submit this form, I have agreed to the conditions.*AcknowledgedNome/Grupo (se aplicável) Name/Group (if applicable)Gênero (Gender)Masculino (Male)/ Feminino (Female)Nome (Name)* Primeiro (Given) Sobrenome (Family) Data de Nascimento (Date of Birth)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Endereço (País de Origem) Rua /Avenida Endereço (Linha 2) Cidade Estado / Província / Região CEP / Código Postal 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 País Email Telefone (Phone)Data de Início da Estadia (Commencement Date of Homestay)DayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Duração da Estadia (Length of Homestay)Please enter a number from 0 to 52.em semanas (in weeks) Quantos outros membros em sua família? (How many other members in your family?)*123456Detalhes do Membro da Família 1 (Family Member 1 Details)Nomes (Given Names) Primeiro (Given) Sobrenome (Family) Idade (Age)Please enter a number from 0 to 100.Relação (Relationship)FatherMotherBrotherSisterOcupação (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherDetalhes do Membro da Família 2 (Family Member 2 Details)Nomes (Given Names) Primeiro (Given) Sobrenome (Family) Idade (Age)Please enter a number from 0 to 100.Relação (Relationship)FatherMotherBrotherSisterOcupação (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherDetalhes do Membro da Família 3 (Family Member 3 Details)Nomes (Given Names) Primeiro (Given) Sobrenome (Family) Idade (Age)Please enter a number from 0 to 100.Relação (Relationship)FatherMotherBrotherSisterOcupação (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherDetalhes do Membro da Família 4 (Family Member 4 Details)Nomes (Given Names) Primeiro (Given) Sobrenome (Family) Idade (Age)Please enter a number from 0 to 100.Relação (Relationship)FatherMotherBrotherSisterOcupação (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherDetalhes do Membro da Família 5 (Family Member 5 Details)Nomes (Given Names) Primeiro (Given) Sobrenome (Family) Idade (Age)Please enter a number from 0 to 100.Relação (Relationship)FatherMotherBrotherSisterOcupação (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherDetalhes do Membro da Família 6 (Family Member 6 Details)Nomes (Given Names) Primeiro (Given) Sobrenome (Family) Idade (Age)Please enter a number from 0 to 100.Relação (Relationship)FatherMotherBrotherSisterOcupação (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOther Sobre Você (About You)Hobbys e interesses? (Hobbies and interests?) Rugby Baseball Surfing Art Photography Reading Watching Movies Swimming Aerobics Listening to music Tennis Sailing Hiking Dancing Scuba Diving Golf Basketball Fishing Soccer Martial Arts Travel Cooking Playing Musical Instruments Como você descreveria sua habilidade de se comunicar em inglês? (How would you describe your English speaking ability?)Very GoodGoodFairPoorVocê prefere uma família com crianças? (Would you prefer a family with children?) Yes No Don't Mind Você tem alguma objeção contra animais domésticos? (Do you have any objection to pets?) Yes No Você fuma? (Do you smoke?) No Yes Yes, but I will smoke outside A maioria das famílias australianas não permite que se fume dentro de casaVocê bebe álcool? (Do you drink alcohol?) Yes No Você é alérgico a algum alimento? (Are you allergic to any food?) No Você não gosta de algum alimento? (Do you have any food dislikes?)Você tem algum problema de saúde? (Do you have any health problems?) No Yes Por favor, especifique. (Please specify)Você toma algum remédio? (Do you take any medication?) No Yes Por favor, especifique. (Please specify)Você gosta de animais? (Do you like animals?) Yes No De quais animais você gosta? (Which animals do you like?) Bird Cat Dog Fish Como você descreveria a si mesmo? (How would you describe yourself?) sociable positive co-operative high achiever shy curious cheerful emotional affectionate nervous quiet serious Você já morou longe de casa antes? (Have you ever lived away from home before?) Yes No Important Note: Homestay families are not necessarily Caucasian in a multinational Australia. You may see homestay families who have migrated into Australia and live as first generation or second generation Australians. They are required to speak English at all times to the students. The structure of the families is diverse including sole adult and with or without children. Many Australian families have pets. Please consider these facts when applying for homestay. Must be completed in English as this form will go to homestay family.*AcknowledgedWe will do our best to find homestay placements, but cannot guarantee that the student's preferences can be met, or that homestay families can be found.*AcknowledgedHomestay search will only begin after the full payment is received.*AcknowledgedFailure to disclose an existing medical condition may result in cancellation of the homestay placement and forfeiture of the homestay placement fee and homestay fees.*AcknowledgedCAPTCHA
