About you

Enter your first name or given name
Enter your last name or family name
Enter your ID number in the format 68902948
Date of birth (select day, month, year)*
What is your gender?*
Enter the country shown in your passport

Contact details

Enter your email address in format: yourname@example.com

What is your current home address?

Enter the unit and/or building name if relevant, like 'Flat 1, Acme House'
Enter your street address, like '128 Valley Road East'
Enter a Rural Delivery number if relevant

Study information

Location of study*
Enter the name and code of your course
Level of study*
How many years have you been studying at Massey?*

Next of kin's details

Provide contact details of your closest living blood relative or relatives, such as a parent.

Enter an email address in format: theirname@example.com

Requirements for homestay

This information will help us to find the most suitable homestay placement. While every effort is made to fulfil your homestay requirements, we cannot guarantee that all of your preferences will be met. 

Start date for homestay (select day, month, year)
Finish date for homestay (select day, month, year)
Do you smoke or vape?
Some homestay hosts will not accept smokers, so we need to take your smoking into consideration
Who would you prefer to live in a home with?
Would you consider staying with a host who has a domestic pet?
Enter any further comments about your homestay requirements for us to consider

Health and medical information

Your health information will remain confidential to the Massey University homestay team and your homestay hosts.

Do you have any pre-existing medical conditions, disabilities or allergies?

If your answer is ‘yes’ please complete a Medical Risk Assessment form at www.insurancesafenz.com/files/PDF/medicalassess_SS_2017.pdf 

Are you taking any medication?
Do you give permission for Massey University to inform your homestay host of the medications you are taking?
Do you have any special dietary requirements?
Enter dietary requirements, like vegetarian, Halal, Kosher, vegan, lactose intolerant, dairy free or gluten-free

There is an additional weekly fee of $60 to cover special dietary requirements. This is payable directly to your host.

Do you have any food allergies?
We need to know your blood type in case of emergency
Do you give permission for Massey University to inform your homestay host of your blood type?
Have you had the MMR (measles, mumps, rubella) immunisation?
Do you give permission for Massey University to inform your homestay host that you have had the MMR vaccination?
Emergency permission - in case of an accident, serious illness or emergency do you agree to being taken to Accident and Emergency at hospital or any other suitable health provider?

Declaration

Declaration
Use your mouse or finger to draw your signature above
Upload an e-signature or image if you are unable to sign above
No File Chosen
File uploads may not work on some mobile devices.
Attachments must be less than 5MB in size

If the homestay boarder is, at the date of signing, under 18 years old then this Declaration must also be signed by the parent or guardian.

Use your mouse or finger to draw your signature above
Upload an e-signature or image if you are unable to sign above
No File Chosen
File uploads may not work on some mobile devices.
Attachments must be less than 5MB in size

Personal information

What words would you use to describe your character?
Select one or more options

Please write a letter which will be given to your homestay host before you arrive. 

The following may provide guidelines for your letter:

  • Have you travelled outside of your home country before?
  • How long have you studied English?
  • What are you studying at present?
  • What do you like to do with your spare time?
  • What are you looking forward to about coming to New Zealand?

You can upload the letter or write it in the space provided in this form.

Upload a letter to your homestay host if you have not written it in the field provided
No File Chosen
File uploads may not work on some mobile devices.
Attachments must be less than 5MB in size
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