Application Form

Family Name:

Given Names:

English Name:

Male Or Female: Male Female

Are You A Smoker: Smoker Non-Smoker

E-Mail Address:

Date Of Birth: Click To Select Date

Country You Are From:

Nearest City To Your Home:

Date To Start Accommodation: Click To Select Date

Date Leaving Accommodation: Click To Select Date

Where Are You Currently Living: Australia Overseas

Mobile Phone Number:

Current Address:

University Course: ELC Degree Course Post Graduate Tafe

What Sort Of Room Do You Want To Live In: Single Room Share With A Friend
Share With My Partner

Name Of Person To Share With:

Preferred House:

Preferred Room Number:

Comments:

Who Completed This Form?: Student Agent

Agent's Name:

Agent's Organisation:

Agent's E-Mail Address:

Agent's Phone Number:

In Case Of Emergency, Please Provide Contact Details For A Relative We Can Contact: Name Of Emergency Contact:

Address Of Emergency Contact:

Phone Number Of Emergency Contact:

Relationship Of Emergency Contact To Student:

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Leases run until the last Saturday in January.