ELC Host Family Application Form

General Information

Thank you for your interest in hosting an ELC international student.

This is a secure form that must be completed in one session. This application form may take some time to complete. You cannot save and return to this form.

To prepare for this, please ensure that you have a recent photo of yourself ready to upload.

PLEASE NOTE that you MUST answer all questions marked with a red asterisk.

Application Checklist
Only proceed with an application if you are willing to provide all the following requirements:

Clean, furnished room with a desk, chair and lamp

3 meals per day, 7 days per week - breakfast, a packed lunch and dinner - plus snacks

a willingness to share Australian life and culture and be prepared to include them in your daily activities as part of your family

your home is accessible by public transport and 50 mins or less from the city centre and you can provide information on stop and route numbers

you must be willing to speak English at all times when the student is present

be living at your home the whole time you are hosting a student; students cannot be left alone in the house or with non-approved people if you travel.

a safe and welcoming home environment.

Eligibility Checklist

To be eligible to be part of the ELC Homestay Program, you must:

Have or be willing to obtain a Police Check or Working with Children Check for all household members over the age of 18.

Accept and adhere to the ELC's Host Family Code of Conduct

Agree to a host family visit by an ELC staff member.

By submitting this application, I agree to provide the above requirements.

I agree

Details About Your Home

Please provide your family name, address and information about your home.

Family Name

(e.g. Smith, John or Doe, John & Jane)

Street Address 1

Street Address 2

Suburb

State

Post Code

Country

How many bedrooms do you have available to host students?

Please provide the email address you would like us to use for all ELC Homestay Program correspondence.

Will the student have their own bathroom?

Please provide the mobile contact number you would like us to use for all ELC Homestay Program correspondence.

Public Transport Information:

Please describe how your student would travel to the ELC, 115 Grenfell Street, by public transport. Please include walking time from home to public transport, mode (bus, train, tram), routes and station or stop numbers.

What is the main language, other than English, spoken in your home (if applicable)?

Sometimes we provide your student with a brief summary of their homestay. Please provide a brief description of your home and family here:

Please attach a recent photo of you and your family:

How did you hear about the Homestay Accommodation Program?

If 'Other" was selected, please provide details below:

Primary Contact

Please provide the name and details of the person who will be the Primary Contact for this homestay accommodation. The Primary Contact is the main person that ELC will correspond and communicate with for this family.

Host Family - Contact - Type

Primary

Emergency

Primary Contact - First Name:

Primary Contact - Last Name:

Primary Contact - Gender:

Female

Male

Primary Contact - Date of Birth:

Country of Birth:

Phone Number (Home):

Phone Number (Mobile):

Primary Contact Preferred Email Address:

Occupation:

Employer:

Do you have a partner or spouse living with you in this Homestay Accommodation? This person will be considered a Secondary Contact (you must provide details of this person on the next page).

Yes

Secondary Contact - First Name:

Secondary Contact - Last Name:

Secondary Contact - Gender:

Female

Male

Secondary Contact - Date of Birth:

Country of Birth:

Phone Number (Mobile):

Secondary Contact Preferred Email Address:

Occupation:

Employer:

Other Household Members

Are there other members in the household, in addition to the Primary and/or Secondary Contact? This may include any children, grandparents, friends or boarders.

Yes

Other Household Members

If there are other people living in the household, in addition to the Primary and/or Secondary contact, please provide details here. This may include any children, grandparents, friends or boarders.

Person 1 - First Name

Person 1 - Last Name

Person 1 - Gender

Female

Male

Person 1 - Relationship to Primary and/or Secondary Contact:

Person 2 - First Name

Person 2 - Last Name

Person 2 - Gender

Female

Male

Person 2 - Relationship to Primary and/or Secondary Contact:

Person 3 - First Name

Person 3 - Last Name

Person 3 - Gender

Female

Male

Person 3 - Relationship to Primary and/or Secondary Contact:

Person 4 - First Name

Person 4 - Last Name

Person 4 - Gender

Female

Male

Person 4 - Relationship to Primary and/or Secondary Contact:

Police Check (or Working With Children Check)

Do you currently hold a valid Australian Police Check or Working with Children Check?

Yes

If yes, please upload a copy of your Police Check or valid Working With Children Check.

Homestay Student Preferences

Please indicate the student homestay preferences that you will be able to accommodate. This will assist the English Language Centre to allocate you a suitable student.

The majority of our students are aged between 18 - 23 years of age and stay from 2 to 5 or 15 to 20 weeks.

Please select if you are able to accommodate male students, female students or both:

Please indicate if you are able to accommodate any of the following dietary requirements a student might have?

Please specify "Other" dietary requirements that you are able to accommodate:

Please indicate if you are vegetarian.

Yes

Are you willing to provide meat daily?

Yes

Please select/tick if you are able to accommodate mature age professional students.

Please select/tick if you are willing to host a student who is a smoker.

Please select/tick if you are interested in hosting students on a longer term (more than 5 weeks) basis?

Please select the areas of interests/activities that you would like to undertake with your student:

Are you able to accommodate a student with the following allergies?

Select "Dog" if you DO NOT have a dog.

Select "Cat" if you DO NOT have a cat.

Select "Bird" if you DO NOT have a bird.

If you DO NOT have ANY pets, please tick ALL boxes below.

Do have you any pets that are not listed above?

Please indicate below:

Please provide details of any previous or current hosting experience, including the name of the program and the organisation.

Smart Question

Yes

Personal Information:

Please note that your personal information collected and held by the English Language Centre will only be accessed and used by people employed or engaged by them as required in the fulfilment of their duties and in a manner consistent with the original purpose stated at the time of collection. Your home address and contact details (home phone/mobile/email), household members and family interests and activities, will be provided to your host student. Please note that this may be distributed via an agent or a representative of the Study Tour group. All other personal information will remain confidential. If you have a short-term study tour student, your home address, home and mobile phone numbers and email address will be included in a standard host family list, so that other host families may contact you.

Support and Reimbursement

We have a dedicated Homestay Coordinator who provides ongoing support to host families and students. All families are visited by the Homestay Coordinator (or ELC Staff Representative) prior to first hosting a student to assess interest, suitability, and concern for the growth and development of the student. Families are also expected to attend information nights when arranged.

We recognise that families become involved in the homestay program because they see it as a rewarding and fulfilling experience. However, we do not expect it to be a financial burden. You are reimbursed with $390 per week to cover costs associated with food, internet, utilities and family-based activities incurred while hosting your student.

Whilst the majority of students stay from 2 to 5 or 15 to 20 weeks in Adelaide as part of an organised Study Tour program, some non-Study Tour students request a longer period of Homestay Accommodation. In these cases, the ELC will organise the first 5 weeks of Homestay with the Host Family as part of the program. After this time, the Host Family and student must come to a private agreement if they wish to continue the Homestay arrangements.

Host Family Agreement

Please read the following carefully:

1. I apply to be a Host Family in the English Language Centre's (ELC) Homestay program for international students.

2. I will cooperate with the ELC, and/or its representatives and understand that the ELC has the right to make all the final decisions concerning placement of students and program scheduling.

3. I consent to providing contact and household information as outlined in the Personal Information section above.

4. I have read and understand the conditions outlined in the Payment and Reimbursement section above.

5. I agree to meet all the essential minimum requirements of the Homestay Accommodation program.

6. I will notify the ELC if our personal or household situation changes, such as moving home, pets or household members.

7. I release the ELC from any liability for any loss, damage, claim or liability we incur which is caused or contributed to by the student.

8. I will indemnify the ELC against any loss, damage, claim, or liability incurred by the ELC in connection with the student’s accommodation with us.

9. I understand that due to student preference it may not always be possible for ELC to provide a student for us to host.

10. I agree to return any residual monies paid as reimbursement for hosting, should it be deemed necessary to relocate a student; and agree to return the money within 7 working days of notification.

Upon receipt of your application, the Homestay Coordinator will acknowledge your application and, in due course, will contact you to arrange a time to visit your home.

I have read and accepted the Host Family Agreement (above) and understand that the English Language Centre accepts my application strictly in accordance with these conditions.

Yes

Host Family Digital Signature

Draw It
Clear

This course is currently not open for enrolments

ELC Host Family Application Form

General Information

Details About Your Home

Primary Contact

Other Household Members

Other Household Members

Police Check (or Working With Children Check)

Homestay Student Preferences