ACCOMMODATION ONLINE APPLICATION FORM

Please use this application to apply for a place in University of Adelaide accommodation.

Your place will be confirmed once your application has been approved. Please be advised that you will not be able to submit this application unless information is provided in all mandatory fields.

Should you have any questions or require assistance to complete your application for accommodation, please do not hesitate to email us at accommodation@adelaide.edu.au or call our office on + 61 8 83035220.

CONTACT DETAILS

Family Name
First Name
Preferred Name
Title
Gender
Date of Birth (dd/mm/yyyy):
Nationality
What language do you speak at home?
Religion (Optional)

CONTACT HOME ADDRESS

Street Address 1
Street Address 2
City
Province/State
Postal Code/ZIP
Country
Telephone
Mobile
Facsimile
Email address

SPECIAL REQUIREMENTS

Please answer the following questions in order for The University of Adelaide to provide you with the most appropriate accommodation to suit your needs. All information provided will be treated as confidential.

Do you have a friend or a relative (they must be studying at The University of Adelaide) whom you would like to live with? Please note they will need to complete their own application form.

If your answer is 'Yes' please provide the name of your friend or relative

	First Name		Last Name

Do you have any other requirements or information to assist us with your application?

Medical
Disability
Diet
Other

ACCOMMODATION OPTIONS


Preferred accommodation 1 :
Preferred accommodation 2 :
Preferred accommodation 3 :

Please select your preferred share accommodation option

COURSE DETAILS

Enrolment Status
Student ID (if applicable)

Course Name

Are you required to undertake a Preparation English Program (PEP) prior to entering your course?
How long will you be studying at The University of Adelaide?

LENGTH OF STAY

Duration
Arrival Date (dd/mm/yyyy):
Departure Date (dd/mm/yyyy):

PAYMENT OF ACCOUNTS

Please indicate who will be responsible for the payment of accounts (e.g. Own Income, parent/guardian, sponsor)

Name of Sponsor
Name of Contact Person (If Sponsored)
Street Address 1
Street Address 2
City
Province/State
Postal Code/ZIP
Country
Telephone
Facsimile
Mobile
Email address

ADDITIONAL INFORMATION

How did you hear about University of Adelaide Accommodation?
If through an agent, please list name of agent

I certify that the information contained in this application is complete and accurate.

Please be advised that the minimum commitment for University Accommodation is one semester. Preference will be given to applications for a full academic year.