Long Term Application

LONG TERM APPLICATION FORM

DATE:

SURNAME:

FIRST NAME(S):

ADDRESS:

POSTCODE:

COUNTRY:

TELEPHONE NUMBER (Inc Dial Code):

FAX NUMBER (Inc Dial Code):

E-MAIL ADDRESS:

(if available)

DATE OF BIRTH:

SEX.. MALE/FEMALE:

RELIGION:

NATIONALITY:

IDENTITY CARD OR PASSPORT NO:

UNIVERSITY/COLLEGE TO BE ATTENDED:

ADDRESS:

POSTCODE:

COURSE TO BE READ:

NAME OF TUTOR:

DATE COURSE COMMENCES: ENDS:

DATES ACCOMMODATION REQUIRED - FROM: TO:

NAME AND ADDRESS OF NEXT OF KIN:

POSTCODE:

COUNTRY:

RELATIONSHIP:

I AM SINGLE/MARRIED I AM A SMOKER/NON-SMOKER

(Please delete appropriately).

MY INCOME IS £ (Monthly) or £ (Annually)

I AGREE TO GIVE A MINIMUM OF 4 WEEKS NOTICE BEFORE LEAVING

* At no time must the Office Tel/Fax No. Be used by Family or Friends.

SIGNATURE DATE

I HEARD OF W.S.H.A. THROUGH UNIVERSITY ETC/ADVERT/FRIEND OR OTHER

APPLICATION DOES NOT GUARANTEE AN OFFER OF ACCOMMODATION

PLEASE RETURN THIS FORM DULY COMPLETED AND SIGNED FOR THE ATN OF:

THE MANAGER, "BLAIN HOUSE", 140-142 BEDFORD HILL, BALHAM, LONDON SW12 9HW, ENGLAND.