University Village - Application Form

mobile: +61 411 564 655
phone: +61 7 5574 6021
fax: +61 7 5594 0224
email: univillage@netspace.net.au

> Application Form

Apply for a room at University Village
Room Rent $185 p.w.

Please fill all the (*) required information

* Full Name:
* University/Campus:
Course Studying:
* Address:	Street Address City/Province/Region State Country
* Phone No:
Mobile:
Fax:
* Email Address:
* Gender:	Male Female
Age:
*Parent's/Guardian's Name:
* Parent's/Guardian's Address:	<Tick this Box if Same as above Street Address City/Province/Region State Country
* Parent's/Guardian's Phone No:
Parent's/Guardian's Email Address:
* Flatmates Preference:	All Male All Female Mixed (both Male & Female)
* Do You Smoke:	Yes No
* Would you prefer to stay with:	Smoker Non-Smoker Doesn't Matter
* Rate Yourself:	Very Quite -----------------------Very Social 1 2 3 4 5 6 7 8 9 10
* Would you prefer to stay with:	Quiet Social Very Social
Your Religion:
Prefer to Stay with as same as your religion:	Yes No Doesn't Matter
* Length of Stay:	1st Sem only (28th Jan - 14th July) 2nd Sem only (15th July - 31st Dec) Both (1st & 2nd Sem) (21st Jan - 31st Dec)
* Arrival Date To University Village:	dd mm yyyy
* Will You Require Car Park: (read more)	Yes No
* Require Linen Pack?: (read more)	Yes No
Additional Information regarding flatmates you would prefer to stay with:

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