TENANCY APPLICATION FORM
PERSONAL DETAILS
Surname
*
Given Names
D.O.B (dd/mm/yyyy)
Gender
Male
Female
ADDRESS
Number and street
*
Suburb
State
Postcode
*
Telephone
*
Mobile no
Email
*
COURSE
Are you enrolled to study at
Deakin University
South West College of Tafe
Name of course enrolled
Year EG 1ST
Have you previously lived on residence at Deakin University Warrnambool
ACCOMMODATION & PREFERENCE
Please select your
Required commencement date:
1
st
Accommodation Preference
SHARED 4 BEDROOM HOUSE
SHARED 3 BEDROOM HOUSE
SHARED 2 BEDROOM UNIT
SINGLE BEDROOM UNIT
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
1
2
3
4
5
6
7
8
9
10
11
12
Year
2008
2009
2010
2011
2012
2
nd
Accommodation Preference
SHARED 4 BEDROOM HOUSE
SHARED 3 BEDROOM HOUSE
SHARED 2 BEDROOM UNIT
SINGLE BEDROOM UNIT
3
rd
Accommodation Preference
SHARED 4 BEDROOM HOUSE
SHARED 3 BEDROOM HOUSE
SHARED 2 BEDROOM UNIT
SINGLE BEDROOM UNIT
4
th
Accommodation Preference
SHARED 4 BEDROOM HOUSE
SHARED 3 BEDROOM HOUSE
SHARED 2 BEDROOM UNIT
SINGLE BEDROOM UNIT
Please supply details of a person to contact should the need arise : Eg: Emergency/Accident.
Surname
Given Names
Number and Street
Suburb
State
Postcode
Email
Telephone
Mobile No
Fax
Please provide any further information you feel may be useful in helping us form a more complete picture of you.
For example: any leadership roles, personal attributes or achievements
REFERENCE
You will need to supply country life with a reference. Please ask your referee to forward the confidential reference form directly to country life accommodation. Please complete the detail of the person you have asked to supply the reference in the space provided. The referee should be your school principal or year 12 coordinator. If you have left school, you should use a university staff member, residence manager, employer or a person of similar standing. References from relatives or family friends are not acceptable.
Referees may be contacted to assist with our selection process.
Surname
Given Names
Relationship to applicant
Where position held
Telephone
Security Code
*
APPLICATION STATEMENT
I (full name)
hereby apply for residency at Country Life Accommodation for the full academic year. I certify that the information in this Application Form is complete and accurate.
Please Note: If at any stage you no longer require this position, please advise us immediately, for the benefit of other students who may be looking for accommodation.
Required Fields
*