Click here to download residential house rules
* Denotes required fields
*Name of Applicant:
*Home Address (when not in residence)
*Home Telephone:
Work:
Fax:
*Email Address:
Date of Birth:
Gender: M F
*Age now:
Next of Kin: (emergency contact)
Address:
(If under 18 please fill out details below)
Name of Parent/Guardian:
Address of Parent/Guardian:
Parents Contact:
Phone
Fax
Mobile

 
MEDICAL CONDITIONS  
Do you have any known medical conditions? YES NO
If yes, please state the conditions. eg. anaemia, anorexia, asthma etc
What treatment is needed in an emergency?
Allergies: Do you have any known allegies? YES NO
If yes, please explain what allegies you have?
DIET  
Do you have any food requirements? (e.g. some foods are forbidden due to religious customs, or allegies, strictly vegetarian) YES NO
Please state your requirements:
Whilst we endeavour to please, we have to prepare meals for the majority. We do include vegetarian dishes. Please feel free to discuss menus or diets with our staff.
ABOUT YOU  
I wish to apply to stay at the Cairns Student Lodge because...
ALLOCATION OF ROOMS  
While your requests will be taken into consideration, we cannot guarantee your preferences:
Please rate yourself on the following scales:
Prefer same language room mate 1 2 3 4 5 Prefer to Study away from the room
Prefer to Study in Room 1 2 3 4 5 Prefer to Study away from the room
Politically conservative 1 2 3 4 5 Politically Liberal
Quiet 1 2 3 4 5 Noisy
Neat 1 2 3 4 5 Messy
Religiously Observant 1 2 3 4 5 Non-practicing
Some clusters and floors can be reserved for Female Students only. Please indicate whether you would prefer this option: Yes No
AIRPORT TRANSFERS
(NO EXTRA CHARGE)		  
Date of Arrival and Flight Details:
Date of Departure and Flight Details:
Please forward applications and fees to: Cairns Student Lodge
10-24 Faculty Close,
SMITHFIELD AUSTRALIA 4878
Briefly state your source of information about - Cairns Student Lodge: International House Embassy CES Web site
Word of Mouth Cairns College of English
Agency Other
If Agency or Other please provide details