* Denotes required
fields
|
| *Name
of Applicant: |
|
| *Contact
Address (when not in residence) |
|
| Car Registration: |
|
| Car Make and Model: |
|
| *Telephone
(H): |
|
| Fax: |
|
| Telephone (W): |
|
| *Email
Address: |
|
| Student #: (where applicable) |
|
| Course of Study: (where applicable) |
|
| *Year
of Study: |
|
| Name of Home University: |
|
| Agency: |
|
| Date of Birth: |
|
| Gender: |
M
F |
| *Age
now: |
|
| Next of Kin: (emergency contact) |
|
| Address: |
|
| Name of Parent/Guardian: |
|
| Address of Parent/Guardian: |
|
| Parents Contact: |
|
|
| 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? |
|
| *Name
of Doctor: |
|
| *Phone: |
|
| *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... |
|
While your requests will be taken into consideration,
we cannot guarantee your preferences:
Please rate yourself on the following scales: |
|
|
| Do you smoke? |
Yes
No
Occasionally |
| Would you live with other smokers? |
Yes
No |
| Clusters and floors can be reserved
for Female Students only. Please indicate whether you would prefer
this option: |
Yes
No |
| I wish to apply for:
|
First Semester
Year |
|
Second Semester
Year |
| Date of Arrival and Flight Details: |
|
| I will be paying for my account
every: |
Two Weeks
Semester in advance |
| All international Students MUST pay all fees and
accommodation charges for the semester in advance. |
If you wish to pay fortnightly you will need to arrange
automatic direct debit into
Cairns Student Lodge Pty Ltd Account.
Details are as follow |
NAME: Source Student Lodge Pty Ltd
BANK: Westpac Smithfield
BSB: 034 158 ACCOUNT: 198 083 |
You will need to ask the bank to use your name as a reference
for the direct credit payment so we can track who
the money is coming from.
OR
Payment by automatic charge against your nominated credit card.
You will need to provide reception with
details of your credit card, and written authorisation to deduct
from your card on the day rent is due.
(Every 2nd Monday) You are required to pay a minimum of 2 weeks
in advance at all times.
Please forward applications and fees to:
Footprints Cairns Student Lodge
10-24 Faculty Close,
SMITHFIELD AUSTRALIA 4878
|
| Briefly state your source of information
about - Cairns Student Lodge: |
JCU Townsville
Word of mouth
JCU Cairns
Web site
Other University
Agency
TV
Newspapers
Other |
| If Agency or Other please provide
details |
|
|
Declaration
I understand that by submitting this application I am applying
for accommodation at Footprints Cairns Student Lodge and if admitted I may
be obliged to pay residential fees for the full semester period
and abide by The Cairns Student Lodge Handbook. I acknowledge
that Footprints Cairns Student Lodge has the right to reject my application.
All information on this application is true and correct to the
best of my knowledge.
This application will be considered and we hope we can offer
you a placement.
|
| |
|
