ࡱ> } @bjbj DSdjdjF00  '''8_'NR:''' QQQQQQQ8UWQQ @ Q''pR;';';' ''Q;' Q;';'JDIN' a3"xK&QR0NRLBY#YLINYINX ;' QQ%l NR Y  :  2026: Off Campus Homestay Accommodation for International Students over 18 years old  Information  All International students who require 51 Homestay Accommodation are required to complete this form as well as an arrival form. Thank you for choosing Homestay, please complete all pages of this form. UNDER18s: Do not fill in this form: Under the New Zealand Ministry of Educations Code of Practice for the Pastoral Care of International Students, if you are under 18 years old, you are required to stay in an approved Homestay or with a Designated Caregiver approved by the 51. Please fill in an Under 18 Accommodation Form if you are under 18 years old. HYPERLINK "/students/accommodation/"/students/accommodation/ This form should arrive at least 3 weeks before your arrival in New Zealand.  Please complete and return to: homestay@waikato.ac.nz Section 1 - Applicant Details  Student ID: _ _ _ _ _ _ _ Date of Birth: ______________(DD/MM/YYYY) Family Name: _______________________________ Gender: ___________________________________ First Name(s): _____________________________ Ethnicity: ________________________________________ Preferred Name: _________________________________ Home Country: __________________________________ Address for reply: ________________________________ Telephone Number: ___________________________ ________________________________________________ ________________________________________________ E-mail: _____________________________________  Section 2 Length of Stay in Homestay  ( 4 weeks Only (Minimum stay) ( 1 - 3 months (Short term) ( 3  6 months (Long term) ( Full Year ( Summer School (Nov  Feb)  Section 3  Type of Accommodation Required Homestay Accommodation (Living with a New Zealand family)  Complete all Pages Please complete all the pages of this form. This information will enable the 51 to place you with a suitable host family. Please note that homestay accommodation is for a minimum of 4 weeks unless the duration of your course is shorter. *This accommodation has been assessed by the University under the New Zealand Ministry of Educations Code of Practice for the Pastoral Care of International Students. *Please note: The University provides a complimentary shuttle from Auckland International Airport for University students (NOTE: If students are only enrolled in an English Language Course, they will need to pay for the Shuttle Service themselves). Additional family members are required to pay their own shuttle costs.  Declaration  I agree to inform the Homestay Office (prior to my arrival) of any changes to my requested accommodation. Students Signature: _______________________________ Date: _________________________________ The 51 has agreed to observe and be bound by the Code of Practice for the Pastoral Care of International Students published by the Ministry of Education. Copies of the Code are available on request from this Institution or from the New Zealand Ministry of Education website at HYPERLINK "http://minedu.govt.nz"http://minedu.govt.nz  Additional Information for Homestay  The information provided will assist us in placing you with a suitable host family. If you are under 18 years of age, DO NOT fill in this form.The Under 18-year-old application form is required ( this can be found on our website) HYPERLINK "/students/accommodation/"/students/accommodation/ Be aware that most of our Homestays are not located close to the University. Many students will need to travel up to 45 minutes by bus to get to the University. This form should arrive in New Zealand at least three weeks before you arrive. Homestay accommodation is for a minimum of 4 weeks unless the duration of your course is shorter.  Compulsory You must attach 1 passport size photograph  Section A - Emergency Contact Details  Name of Parent / Guardian: _____________________________ Address: ______________________________________ Can they speak English? ( Yes ( No ___________________________________________ If NO, which language(s) do they speak? __________________ ___________________________________________ Country: _____________________________________________ Telephone No: _______________________________ E-mail: ________________________________________________  Section B Course of Study  What course of study have you applied for: _________________________ When does your course start ?:__________________ Expected length of Study: ( One academic year ( One semester Have you received: ( Formal Offer ( Conditional Offer ( Your Visa  Please indicate your student category: ( Private paying student ( Exchange Programme (please specify University and/or Programme) ________________________________________ ( Study Abroad Programme (please specify which Programme) _______________________________________________ ( NZAID Scholar Recipient (please specify your particular award) ____________________________________________ ( Other (please specify) ______________________________________________________________________________  Section C Health and Dietary Requirements  The purpose of this section is to help the University to be of maximum assistance to you during your stay in New Zealand. Mild physical and psychological disorders can become serious under stresses of life while studying abroad. It is important that we are aware of any medical or emotional problems, past or current, which might affect you in a foreign context. The information provided will remain confidential. It will only be shared with the necessary 51 staff and/or appropriate professionals, and Homestay Host this is only if it is pertinent to your well-being. This information will not affect your admission to the 51.  Do you have a disability or medical condition: ( No ( Yes (if yes, please explain)  Are you in good physical health? ( Yes ( No (if no, please explain)  Have you ever been treated, or are you currently being treated for any psychological or emotional problems: ( No ( Yes (if yes, please explain)  Are you taking medication? ( No ( Yes (if yes, please explain) Do you have any allergies to medication or food? ( No ( Yes (if yes, please explain) Do you plan to bring an EpiPen? ( If YES, please fill out the EpiPen Action Plan form  Have you had any major injuries, diseases or ailments in the past 5 years? ( No ( Yes (if yes, please explain)  "Smokingand vaping are not allowed at an Univeristy of Waikato Homestay or at the University if you smoke or vape be aware that you will not be able to smoke or vape at your Homestay or the University . Failing to abide by this could result in being asked to leave your Homestay"  8. Do you have any special dietary requirements? ( No ( Yes (if yes, please indicate the foods you DO NOT eat) ( Chicken ( Pork / Ham / Bacon ( Halal ( Lamb / Mutton (sheep meat) ( Beef ( Eggs ( Fish ( Dairy products e.g. milk, cheese, yoghurt ( I do not eat any meat or animal products ( Other (please explain) _____________________________________________________________________________________  9. If you are a Vegetarian or Vegan, do you mind living with a family who eats meat? ( Yes ( No  Section D Accommodation Requirements  10. Do you want to live in a home with children? (Please tick the appropriate boxes)1 ( No children0. ( Infants 0-5 years ( Children 5-12 years ( Teenagers 13-17 years ( Other international Students  11. Do you want to live with a family that has pets? (Many families have a dog, cat or bird) Inside House ( Yes ( No Outside ( Yes ( No  12. Are there any specific animal/s you are allergic to? ( No ( Yes (if yes, please specify) (if yes, a medical certificate is required with this application. If a certificate is not supplied, we will not guarantee that the family will meet these requirements.  13. Are there any specific animals you do not like? ( No ( Yes (if yes, please specify)  14. Do you have any special requirements for cultural or religious events? ( No ( Yes (if yes, please explain)  15. Interests and Hobbies: ( Reading ( Sports ( Music ( Computing ( Travel/sightseeing ( Cooking ( Other (please specify) _______________________________  16. Would you consider yourself: ( Quiet ( Outgoing/Sociable ( Adventurous ( Other (please specify) ____________________  17. The purpose of this section is to assist us in making the best match of student to homestay host. Please write a paragraph to describe yourself. Include personal, cultural and/or sporting interests or other specific information that will assist us in choosing your Homestay family.  Section E Accommodation Fees  Homestay Administration fee : $490.00 + First 4 Weeks Homestay fees : $1568.00 = $2058.00 Additional Weeks $392.00 Please Tick Below if you have special requirements: (An additional fee may be charged if the Student has Additional Special Needs such as dietary requirements (Halal, Lactose Intolerant, Gluten Free) Where the family needs to buy special foods, Allergies where the family is required to be on high alert (use of an epipen is required), identified Medical Issues where families are expected to provide a high level of Medical Awareness (Epilepsy, diabetes, Asthma). As well as identified Mental Health Issues such as depression, autism, ADHD, bi-polar where a family needs to be alert to the students additional requirements for their well-being. This will be evaluated on a case-by-case basis.  ( I authorise a payment of $2058.00 Please write the numbers below clearly so we can process your payment. Students Name: ________________________________ Student ID Number: _____________________________ Credit Card Type: _______________________________ Card Holders Name: _____________________________ (Visa and Mastercard only) Card Number: _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _ Expiry Date: _ _ / _ _ Card Holders signature: _______________________  ( I have enclosed an international bank draft for NZ $2058.00 made out to The 51. ( I have sent these funds with my Tuition fees payment to the 51.  SECTION E Homestay Declaration ( I have enclosed the appropriate fee and passport sized photographs. 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