EmailMe Form - Ely | Application Form (Summer)

1| PERSONAL DETAILS

Name *

First Last

Passport photo

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Date of birth *

DD / MM / YYYY

Home telephone number

[please indicate country and area codes, e.g. +353 1 ...]

Mobile number *

[please indicate country and area codes, if applicable]

Email address *

Names of parents/guardians

Occupation of parents/guardians

Number of brothers

Number of sisters

Nationality *

Religion *

How did you hear about Ely University Centre? *

2| ACADEMIC DETAILS

University *

[being attended or that you hope to attend]

English academy

[if applicable]

Is English your first language?
If not, what is your first language? *

Please specify your level of English

3| PERSONAL PROFILE

Cultural interests *

Other interests *

Have you ever held positions of responsibility?

[please give details]

Any other comments that you think might favour your application?

4| APPLICATION DETAILS

Have you ever stayed in a university residence before? *

Yes

No

Is a university residence your first choice of accommodation type? *

Yes

No

Is the choice of a university residence something that you want yourself? *

Yes

Other

[and not just the choice of your parents, for example]

Are you applying for any other type of accommodation? *

Yes

No

If called for interview, when might you be available? *

DD / MM / YYYY

Estimated arrival date *

DD / MM / YYYY

Estimated departure date *

DD / MM / YYYY

Referee *

[a referee is a person who gives information about your character and ability; please include their contact details; you may be required to submit a character reference from your referee at a later stage]