Application Form: for the Academic Year 2011-2012
Campus Accommodation Application Form


Academic Status    
Current Year       
Personal Information
Title     Gender
First Name   Surname  
Date of Birth     Nationality  
If yes details or are there any requirements    
University College Cork Details
CAO Number/Student Number  
What college shall you attend. Course of Study  
International Visiting Student University/Agency Co-ordinator
Home University / Agency Name
Contact E-mail   Contact Phone No   
Contact Information
E-mail   Mobile Phone   
Do you agree to be sent text messages relevant only to Campus accommodation, e.g. social events, important dates etc. There is no charge for this service. Your details will not be shared with any third parties
Home Address Parent/Guardian Details
Parent/Guardian Name
Street Address   Street Address  
Town/City   Town/City  
County   County  
Post Code   Post Code  
Country   Country  
Telephone   Telephone
Mobile No  
 
Accommodation Preferences
Booking Period  
Expected Arrival Date                                          
Expected Departure Date                                    
Please Note:We try our best to give students their preference but this is not always possible.
Only select room types that you are willing to accept if 1st choice is not offered 
1st Choice* - Apartments/Room Type   
2nd Choice* - Apartments/Room Type 
3rd Choice* - Apartments/Room Type
         
Room Share
Please Note: We do not guarantee who your room mates will be.
Apartment Share 1  
Apartment Share 2  
Apartment Share 3  
Apartment Share 4
Apartment Share 5
General Info
Where did you hear about us?   Specify Details :
Additional Information
Bank Details (These are for refund purposes only)
Please note the transfers will take 3-5 working days to reach your account.
Bank Name   Bank Address 1  
Please indicate who the account holder is:   Name of Account Holder
Please indicate origin of the Bank
Bank Account Number    Bank Sort Code --      
If non-Irish A/C please specify the following(Transfers to Bank Accounts outside of Ireland will be subject to a banking charge deduction):
Bank IBAN Account Number Bank BIC Swift Code
I have read the & understood the   Terms and Conditions