Arrival Flight# Arrival Time: Date of Arrival:
Dept. Flight# Dept. Time: Date of Departure:
Please note that if you arrive later than 17.30, you will not be able to move into your homestay until the next morning.
Accommodation Details
Homestay request:
room only (very limited availability) - $150 per week
room and breakfast (very limited availability) - $170 per week If your above choice is not available, please indicate your preference from the following options.
half board: breakfast and dinner (lunch on weekends) - $220 per week
full board: all meals - $240 per week
Date commencement of homestay: Date of completion: (minimum 2 weeks)
Please note that we cannot guarantee placement if your arrival date is within 4 weeks. No applicants will be accepted if arrival date is within 10 days.
Special meals: Are you a vegetarian?yes no Do you require a special diet?yes no
If yes, please provide details:
Allergies: Do you have any allergies?yes no
If yes, please provide details:
Medical conditions Do you have any physical or medical disabilities or conditions? yes no
If yes, please provide details:
Personal preferences: Would you like a family with children?
dont mind
Yes - children of any age
Yes - children aged 0-5
Yes - children aged 6-13
Yes - children aged 14-17
No children
Are you willing to stay where there are pets?yes no If no, please indicate which animal you do not like
Do you smoke?yes no
If yes, do you agree not to smoke in the familys house?yes no Internet availability: What is the importance of having internet at your homestay?
very important quite important not important
Please tell us a little about yourself: your interests, activities you like doing, personality characteristics, for example, sociable, independent, confident, quiet.
Temporary accommodation request:
room at a hostel Date to arrive at hostel: Expected departure date:
Airport meeting and transfer request:
Do you require airport meeting and transfer?yes no If yes, provide details
Arrival date in Perth Time Flight number
PIBT/ECU Mt Lawley Student ID number (if free pick-up required):
Payment details
Use the following checklist to calculate the amount payable.
Homestay placement fee: $190
$
Hostel placement fee: $40
$
Temporary hostel accommodation: Single room in hostel: $40 per night Self contained appartment: $100 per night
$
Airport meeting and transfer: $95 (free service for new PIBT/ECU Mt Lawley students)
$
International Bank Fee (if applying from outside Australia) - $55
$
Total Owing:
$
I have read and accept the terms and conditions contained within the student guidelines. I understand that the placement fee is not refundable, once a host family profile has been provided.
Please make payment to the following bank account:
Account name: Nacel Australia
Account no: 018260-9
Bank name and address: BankWest, 100 James St, Northbridge WA 6003, Western Australia
BSB: 306-053 SwiftCode: BKWAAU6P
Please give a copy of this page to your bank when making telegraphic transfers or arranging a bank draft. Provide your name on all payments/bank transfers.
