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占쏙옙

HOMESTAY

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Accommodation Placement Form

占쏙옙
Student Information
First name Family name
Nationality Male Female Date of Birth
Home Address
City/Town Country Postal Code
Phone No. Fax No. First Language
Email 占쏙옙 占쏙옙
In case of emergency contact - Auckland area (if known)
Name Phone Fax
Name Phone Fax
Please tell us about yourself
Do you like pets? No       Yes        
Do you like children? No       Yes      
Do you smoke? No       Yes     If  Yes, how much?
Please indicate your English level                                               0=no english  /  6-advanced
0          1          2          3          4          5          6
Countries you have visited? Any Medical or diet requirement?(dueto,allergies,relirion,etc)

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Reservations
Would you like Homestay? ($24/night, payable directly to your host family) No          Yes
If yes, please indicate Long term(6,10,12 weeks)            
Short term(one month)
Name of program in which are you registered  
Program dates for which you require accommodation
Would you like Airport welcome? No          Yes
If yes, please indicate
Arrival date      Airline      Flight #      Arrival time  

      

Payment Information

Airport Welcome Fee $50
Homestay Placement Fee  $150   
Homestay Fee $195/week


You pay a homestay placement fee directly to the SECS and a daily homestay rate directly to the host family.

Payment Method 

Tuition and fees may be paid by bank draft or by T/T in New Zealand Funds, payable to

The Sheffield English Language School

  A/C#        

ASB Bank     

Queen Street 

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Declaration of Applicant

I agree to comply with all rules and regulations of the Sheffield English Language School

present and future.    If I plan to move out from my host family's home, I agree to tell the 

host family 1 week before the day I move.  

I agree to purchase adequate medical coverage during my stay in New Zealand. 

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To submit this application

Via fax: Download the printable version of this form, fill it out in full, and fax it to us at 64-9-309-6002.

Via mail: Download the printable version of this form, fill it out in full, making sure to 

include your cheque, or copy of T/T receipt plus photographs in the envelope, and mail it to:

Student Services

Sheffield English Language School

303, Dilworth Bldg., 22-32 Queen Street, Auckland , New Zealand