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STUDENT ACCOMMODATION APPLICATION FORM

UniLodge @ UQ St Lucia
* Compulsory field. Please print clearly.
Please complete the following application form to apply for residency at UniLodge. The room will not be held for you until the application has been approved and 4 weeks rent (cleared funds) has been paid to UniLodge. Cancellation Information: A cancellation fee of 4 weeks rent will apply to cancellations made less than 1 month prior to the start date of your lease (as per your letter of offer).

First Name* Gender* Female Male Date of Birth*

Family Name* Will you be under 18 on arrival?* Proposed Departure Date* Cleaning Preferences* $55 per hour minimum 1 hour Weekly Plan C Installments (monthly) Quarterly Up front payment Fortnightly Not required Monthly Yes No

Proposed Arrival Date* Accommodation Preferences* List in preference order 1, 2 & 3


("1" being your first preference) preferences cannot be guaranteed

1 Bedroom in a 2 Bedroom Apartment Plan A Payment Plan* Welcome Pack ($150) Plan B

1x double sheets, 1x towel, 1x bathmat, 2x pillow cases, 2x pillows, cutlery set for 1 (knife, fork, soupspoon & teaspoon), dinner plate, smaller plate & bowl Other requests - If you have any special requests please list them below requests cannot be guaranteed.

Personal Details Nationality* Home Country Address* Home No. Mobile No.* Medical Conditions (incl. disabilities) Emergency Contact Details Name* Home No.* Australian Residents* Aust. Drivers License No.* Non-Australian Residents* Passport Number* Australian Visa No.* Education Information (e.g. university, college, school etc) Name of Education Institution* Name of Course* Agent Details Did you hear about UniLodge through an Agent?* What is the name of the Agency?* Signature* Start Date* End Date* Expiry Date* Expiry Date* State* Expiry Date* Relationship to you* Mobile No.* Email* Fax No. Parent/Guardian Name (if under 18*)

Yes

No

Are you applying through this Agent? City Location* Date*

Yes

No

Please Email this form to stlucia@unilodge.com.au


Office Use Only

Number

Room Type

Lease ID

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