ACCOMMODATION SERVICES Homestay Host Application Host 1 First name: Occupation: Male/Female: Last name: Date of birth (DOB): Mobile number: Daytime contact number: Email address: Host 2 First name: Last name: Occupation: DOB: Male/Female: Mobile number: Daytime contact number: Email address: Home address: Street address: Suburb: Postcode Home phone number: (03) www.utas.edu.au/accommodation 1
Please list ALL residents in the home (related or not) AND family members not currently living at home: www.utas.edu.au/accommodation 2
About you and your family Reasons for hosting: Any members travelled/lived overseas? Yes No If yes, who travelled and to which countries? Any members speak or study a foreign language(s)? Yes No If so, who speaks and which language(s)? What activities does your family do together? Watch TV Watch movies Eat meals Take walks Play sports Go shopping Go on picnics Go sightseeing Computer games Cook Visit markets Play music List other family interests: Are you actively religious? Yes No If yes, which religion? Special diets: Vegetarian Vegan Gluten-free Other Smoking: Do any family members smoke? Yes (Inside Outside ) No Do you have written house rules? Yes No *It is helpful if the house rules are discussed with the student upon arrival. Homestay host level of interaction with student Host at home Weekends Meal times www.utas.edu.au/accommodation 3
Pets Inside Outside Inside Outside Inside Outside Your home Lounge room/family room: Television DVD Stereo Foxtel/Cable Other Kitchen Access for student Yes No Clean Safe Microwave Bathroom(s) B1 B2 Comments Shower Bath/shower over bath Shower curtain/screen Door locks Floor water resistant Basin Mirror Power point Toilet Separate toilet Laundry Host will do laundry Student to do own laundry Washing machine Dryer Clothes line Drying racks Safe Family bedroom(s): How many? 1 2 3 4+ www.utas.edu.au/accommodation 4
Student bedroom(s) B1 B2 B3 Bed Bedding Wardrobe/hanger Drawers Heating Desk Lamp Chair Windows Natural light Curtains Door locks (not compulsory) Stairs: Safe Handrail Trip hazards List: Other areas/rooms Please describe (e.g study/library; family room) Outdoor areas please describe (eg garden/pool/yard area/etc) Are there any areas the student is not allowed to access: Yes No Please list: www.utas.edu.au/accommodation 5
Services available (for student use) Telephone Yes No Usage Phone card Mobile calls Local calls International calls Internet Available for use Yes No Broadband Dial up Is usage limited Yes No Emails only Basic use Full use Will you charge for usage Yes No If yes, what would you charge? Computer Available for student use? Yes No Transport Student will get to UTAS by: Bus Route(s): Proximity to bus stop Car (Host can drive) Walk Distance/time: Other Distance to University Student preference Preferred gender Male Female Either Preferred countries Smoker: Yes No If yes, smoking is acceptable inside outside www.utas.edu.au/accommodation 6
Dietary needs of student host can accommodate: Vegetarian Vegan Gluten-free Other What, if any, household chores will your student be asked to do while living with you? Wash dishes Clean own room Own laundry Help prepare meals Clean bathroom Vacuum Garden Other Message to your student Please provide photos of your family, home/living space, including student bedroom(s). Please email this form and photos/video to the Homestay Coordinator. Alternatively, post to the address provided below. Thank you HOBART LAUNCESTON Camille Hoffman Andrea McCarron homestay@accommodation.utas.edu.au homestay@launceston.utas.edu.au Private Bag 94 Locked Bag 1367 Hobart TAS 7001 Launceston TAS 7250 03 6226 1998 03 6324 3917 11/2014 www.utas.edu.au/accommodation 7