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COISCÉIM STUDENT VILLAGE ACCOMMODATION

APPLICATION FORM 2014/2015

PLEASE OPEN THE FOLLOWING DOCUMENT, COMPLETE THE FORM IN BLOCK CAPITALS AND RETURN IT TO US VIA POST OR EMAIL.

Microsoft Word version: Application Form

IF YOU HAVE BEEN ACCEPTED INTO COISCÉIM STUDENT VILLAGE, YOU SHOULD DOWNLOAD THE FOLLOWING CONTRACT AND GUARANTOR DOCUMENTS, COMPLETE THEM AND RETURN THEM TO US AS SOON AS YOU CAN.

Contract        Guarantor Document

IF YOU CANNOT OPEN THE ABOVE APPLICATION FORM, PRINT THE FOLLOWING AND RETURN IT TO US AT YOUR CONVENIENCE.

PERSONAL DETAILS

1. SURNAME: ____________________________________________________________

2. FIRST NAMES: _________________________________________________________

3. ADDRESS: _____________________________________________________________

_________________________________________________________________________

4. NATIONALITY: ___________________________

5. TELEPHONE NO.: _________________________ MOBILE NO.: _________________

6. EMAIL: __________________________________

7. DATE OF BIRTH: __________________________

8. GENDER: MALE _____ FEMALE _____

9. COLLEGE COURSE: ________________________

10. COLLEGE YEAR: _________________________

11. EMERGENCY CONTACT DETAILS: ______________________________________

_________________________________________________________________________

ACCOMMODATION DETAILS

12. PLEASE TICK ACCOMMODATION PREFERENCE:

STANDARD BEDROOM _____ TWIN BEDROOM _____ DELUXE BEDROOM _____

13. PLEASE TICK HOUSE TYPE PREFERRED:

MALE _____ FEMALE _____ MIXED _____ SMOKING _____ NON SMOKING _____

14. HOW DO YOU WISH TO PAY?

FULL ACADEMIC YEAR PAYMENT _____

PART ACADEMIC YEAR PAYMENTS _____