APPLICATION FOR RESIDENCE FOR OFFICE USE

ACADEMIC SESSION – 2010/11

COMPLETE THIS FORM IMMEDIATELY – Use BLOCK CAPITALS throughout.

4. UCAS Personal ID Number

1. Title (Mr/Mrs etc.) 2. Surname/Family Name 3. First/Other Names (Undergraduates only)

5. Sex () 6. Marital Status () 7. Date of Birth 9. Admissions/Application Number

Male Female Single Married Civil Partnership Day Month Year 8. Nationality (Graduate or Affiliate Students)

10. Programme (e.g. BSc) 11. Subject (e.g. Neuroscience) 12. Department (e.g. History) 13. Previous School/University

14. Permanent Home Address

FOR OFFICE USE

Year Priority

Postcode/Zip Tel No. (with code)

Email Fax No. (with code)

15. Correspondence Address (if different from above) Valid from: Until: Special Ack.

Postcode/Zip Tel No. (with code)

Email Fax No. (with code)

16. Name of Parent/Guardian/Next of Kin, and Address (if different from above)

Recent passport size

Postcode/Zip photograph of yourself
Tel No. (with code) Fax No. (with code) MUST be stapled here.
Relationship

17. In 2010/2011 I will be a () and I will be in the ()

Full-time Part-time Undergraduate Graduate 1st 2nd 3rd 4th 5th year

or or or or or or

student on a ()
Exchange JYA (Junior Year Abroad)
Recent passport size
or photograph MUST be
stapled here.
18. I have previously lived within the M25 motorway when a student () Yes No
If yes, please state full postal address and dates (This second
photograph should be
of YOU if you are
applying for SINGLE
person accommodation
19. Personal activities and interests or of your PARTNER
if you are applying
My main interests are:
for COUPLED
accommodation).

Applications will
20. Please give details of any disability, illness or other special needs NOT be considered
unless accompanied
by TWO photographs.
21. EITHER A. For Applicants Requiring SINGLE PERSON Accommodation
Yes No Full name and department of another
Do you want to share a room (single beds)? ()
applicant with whom you are prepared
Will you want to share a room if no single rooms are available? () Yes No to share (if any):

Do you smoke? () Yes No

Twin rooms are non-smoking if occupied by at least one non-smoker.

Please note: We will consider your preference, but may not be able to meet it. Applicants 19 years and under are likely to be offered shared rooms if
placed in self-catering accommodation.

OR B. For Applicants Requiring COUPLED Accommodation (married or in a civil partnership)

Please state Full Name of your Partner:

Please indicate any programme of study or employment in which your Partner intends to engage:

Please indicate number of children, their sex and ages, for whom accommodation is also required: (9/H/I/J/K)

22. Dates Accommodation Required If Not For The Entire Session (27 September 2010 – 17 June 2011) (See www.ucl.ac.uk/accomapply)

From To

23. For Prospective Undergraduates and Graduates

Please indicate any preference you may have for the type of accommodation required by placing ‘1’, ‘2’, ‘3’, etc. in the relevant boxes below.
We cannot guarantee to meet your preference.
Order of Choice Order of Choice

UCL Halls of Residence (meals provided) (X) UCL Student Houses (self-catered) (Y)

Intercollegiate Hall (meals provided) (N) No preference (^)

For Intercollegiate Halls only please name your 1st and 2nd preferences.

1st preference 2nd preference

24. For all Applicants

Please indicate the single most important factor to you in your preference for accommodation with a () in only one of the boxes.

Catered Hall (X) Self-catered House (Y) Single Room (0) With PG/Mature Students (D)

En suite bath (E) Computer Points (O) Shared Flat (*) Proximity to UCL (P)

Low cost (A) Car Parking (I)

Other (Please state)

Please indicate the MAXIMUM weekly rent you are prepared to pay for your preferred type of accommodation: £ per week

25. For All Applicants (This is not used for selection purposes but to assist in the preparation of Electoral Registration Lists.)

If you are a citizen of the United Kingdom, Eire, or the British Commonwealth and will be eligible to vote in British Elections subsequent to
1 December 2010 please place a () in the box below. (Failure to do so may mean that you will not be registered to vote if you obtain a place in a
UCL or University residence.)

I will be eligible to vote in British elections

If you are a citizen of an EU state other than the United Kingdom or Eire and will be eligible to vote in EU Elections subsequent to
1 December 2010 please place a () in the box below. (Failure to do so may mean that you will not be registered to vote if you obtain a place in a
UCL or University residence.)
Please place a () in the box if you want your details to appear in the edited list
I will be eligible to vote in EU elections
which can be purchased from Electoral Services offices by anyone for any purpose.
Declaration: I understand that omissions or falsifications of this application form render it invalid and that final acceptance will depend on my agreeing
to abide by the Rules and Regulations of the Hall or House. I accept that the prompt payment of residence fees within the period set out in the
regulations is a condition of residence.

Signed Date

It is imperative that only one form is completed for ALL UCL and University residences. The completed application form should be returned
immediately to: UCL Student Residences, University College London, 117 Gower Street, London WC1E 6AP.

PLEASE NOTE that it is your responsibility to ensure the safe arrival of this application form. All forms received will be acknowledged. Please
contact UCL Student Residences if you do not receive an acknowledgement of receipt of this application within four weeks of returning it to UCL
Student Residences.

DATA PROTECTION ACT – UCL Student Residences will use the information given on this form for administrative purposes only. The information will
be destroyed in accordance with the UCL Data Protection Policy.