Name:

Email:

Gender:

Nationality:

Street Address:

Suburb / City:

Country:

Postcode (ZIP code):

Phone number:

Have you worked as an au pair before/ housekeeper or nanny?

Have you had experience with house work or minding children

Do you have a driver's license?

Do you smoke?

Age:

Start:

Languages fluently spoken:

Which program are you interested in? (You can choose more than one)

Do you have a particular area that you wish to live in?

Do you have a Working Holiday visa for Australia?

Do you have a Student Visa for Australia?

Allergies:

Please indicate here that you can afford to live in Australia.

I'm aware that evidence needs to be provided that the financial conditions are met; otherwise the application will not be progressed. Please be prepared to provide scholarship appovals on request.