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)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Địa 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 DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin 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)Day12345678910111213141516171819202122232425262728293031Month123456789101112Year20202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Thời 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?)YesNoDon't MindBạn có phản đối gì đối với thú cưng không? (Do you have any objection to pets?)YesNoBạn có hút thuốc không? (Do you smoke?)NoYesYes, but I will smoke outsideHầu hết các gia đình ở Úc không cho phép hút thuốc trong nhàBạn có uống rượu bia không? (Do you drink alcohol?)YesNoBạn có dị ứng với thực phẩm nào không? (Are you allergic to any food?)NoBạn 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?)NoYesVui lòng ghi cụ thể (Please specify)Bạn có dùng thuốc gì không? (Do you take any medication?)NoYesVui lòng ghi cụ thể (Please specify)Bạn có thích động vật không? (Do you like animals?)YesNoBạn 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?)YesNoCAPTCHA
