Homestay Application Form – Đơn đăng ký ở trọ gia đình bản xứ Student Homestay Application Form - Vietnamese Step 1 of 3 33% Tên/ Nhóm (nếu có) Name/Group (if applicable) Giới tính (Gender) Nam (Male)/ Nữ (Female)Tên (Name)* Tên của bạn (Given) Họ của bạn (Family) Ngày sinh (Date of Birth)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Địa chỉ nhà (Home Address) Tên Đường phố Địa chỉ 2 Thành phố Tiểu bang / tỉnh / vùng Mã bưu điện AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Quốc gia Email Điện thoại (Phone)Ngày bắt đầu ở trọ (Commencement Date of Homestay)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Thời gian ở trọ (Length of Homestay)Please enter a number from 0 to 52.trong tuần (in weeks) Có bao nhiêu thành viên nữa trong gia đình của bạn? (How many other members in your family?)*123456Chi tiết thành viên gia đình 1 (Family Member 1 Details)Tên (Name) Tên của bạn (Given) Họ của bạn (Family) Tuổi (Age)Please enter a number from 0 to 100.Mối quan hệ (Relationship)FatherMotherBrotherSisterNghề nghiệp (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherChi tiết thành viên gia đình 2 (Family Member 2 Details)Tên (Name) Tên của bạn (Given) Họ của bạn (Family) Tuổi (Age)Please enter a number from 0 to 100.Mối quan hệ (Relationship)FatherMotherBrotherSisterNghề nghiệp (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherChi tiết thành viên gia đình 3 (Family Member 3 Details)Tên (Name) Tên của bạn (Given) Họ của bạn (Family) Tuổi (Age)Please enter a number from 0 to 100.Mối quan hệ (Relationship)FatherMotherBrotherSisterNghề nghiệp (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherChi tiết thành viên gia đình 4 (Family Member 4 Details)Tên (Name) Tên của bạn (Given) Họ của bạn (Family) Tuổi (Age)Please enter a number from 0 to 100.Mối quan hệ (Relationship)FatherMotherBrotherSisterNghề nghiệp (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherChi tiết thành viên gia đình 5 (Family Member 5 Details)Tên (Name) Tên của bạn (Given) Họ của bạn (Family) Tuổi (Age)Please enter a number from 0 to 100.Mối quan hệ (Relationship)FatherMotherBrotherSisterNghề nghiệp (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOtherChi tiết thành viên gia đình 6 (Family Member 6 Details)Tên (Name) Tên của bạn (Given) Họ của bạn (Family) Tuổi (Age)Please enter a number from 0 to 100.Mối quan hệ (Relationship)FatherMotherBrotherSisterNghề nghiệp (Occupation)Accounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityClerical/AdministrativeConstruction/FacilitiesConsumer GoodsCustomer ServiceEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryGreenHealthcareHospitality/TravelHuman ResourcesInstallation/MaintenanceInsuranceInternetJob Search AidsLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerPharmaceutical/BiotechProfessional ServicesQA/Quality ControlReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchSkilled LaborTechnologyTelecommunicationsTransportation/LogisticsOther Về bạn (About You)Sở thích và quan tâm? (Hobbies and interests?) Rugby Baseball Surfing Art Photography Reading Watching Movies Swimming Aerobics Listening to music Tennis Sailing Hiking Dancing Scuba Diving Golf Basketball Fishing Soccer Martial Arts Travel Cooking Playing Musical Instruments Bạn mô tả khả năng nói tiếng Anh của mình thế nào? (How would you describe your English speaking ability?)Very GoodGoodFairPoorBạn có muốn ở cùng với một gia đình có con nhỏ không? (Would you prefer a family with children?) Yes No Don't Mind Bạn có phản đối gì đối với thú cưng không? (Do you have any objection to pets?) Yes No Bạn có hút thuốc không? (Do you smoke?) No Yes Yes, but I will smoke outside Hầu hết các gia đình ở Úc không cho phép hút thuốc trong nhàBạn có uống rượu bia không? (Do you drink alcohol?) Yes No Bạn có dị ứng với thực phẩm nào không? (Are you allergic to any food?) No Bạn có ghét món ăn nào không? (Do you have any food dislikes?) Bạn có vấn đề nào về sức khoẻ không? (Do you have any health problems?) No Yes Vui lòng ghi cụ thể (Please specify)Bạn có dùng thuốc gì không? (Do you take any medication?) No Yes Vui lòng ghi cụ thể (Please specify)Bạn có thích động vật không? (Do you like animals?) Yes No Bạn thích động vật nào? (Which animals do you like?) Bird Cat Dog Fish Bạn mô tả bản thân mình như thế nào? (How would you describe yourself?) sociable positive co-operative high achiever shy curious cheerful emotional affectionate nervous quiet serious Bạn đã bao giờ sống xa gia đình trước đó chưa? (Have you ever lived away from home before?) Yes No CAPTCHA Δ
