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UniLodge on Flinders Application Form


unilodge.flinders@unilodge.com.au
 
First Name:
Family Name:
Gender: Male Female
Date of Birth :
Will you be under 18 on arrival? Y N

Proposed Arrival Date:

Proposed Departure Date:
   
Accommodation Preferences
(You must list at least 3 bedroom type preferences 1 to 3 with "1" being your first preference)
   
Studio One Bedroom Apt
Standard Standard
Superior Superior
Deluxe  
   
Two Bedroom Prefered Position / Level
Standard Low Level High Level
Superior  
   
Payment Plan: Instalments Up Front Payment
   
Nationality:
Parent / Guardian Name:
Home Country Address:
Telephone No:
Fax No:
Mobile No:
Email:
Emergency Contact Name:
Emergency Number:
   
Medical Conditions (Incl. disabilities):
Passport Number:
Expiry Date:
Australian Visa Number:
Expiry Date:
   
Name of Course:
Name of Institution:
Start Date:
End Date:
   
Did you hear about UniLodge through an education agent: Yes No
If yes, please indicate the agency name:
Agent's City Location:
Are you applying to UniLodge through an/this education agent?: Yes No
   
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Contact details
UniLodge on Flinders
238 Flinders St
Melbourne
VIC 3000

Tel: 61 3 9224 1500
Fax: 61 3 9224 1530

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What our students say...

Great place to stay with marvellous friendly staff......
Iskandar Isehak – QUT

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