138 Student Living

UWI, Mona Campus

Hall of Residence Application Form - 2018/2019 Academic Year

Form must be completed and submitted by email to:

A passport size picture will be required on acceptance of a room on 138 Student Living

Section A

ID: / Faculty: / DOB:
Last Name: / First Name: / Middle Name:
Email Address: / Telephone No: / TRN:
Nationality: / Gender:

Address (Home):

Section B

  1. Are you a new or returning student? ⃝New⃝Returning
  2. Have you previously lived on Hall?⃝ Yes⃝ No

If answer is yes please state which hall______.

  1. Please state floor preference1st , 2nd, 3rd, 4th, 5th, 6th
  2. Indicate your Hall Preference:Leslie Robinson Hall, George Alleyene Hall,

Irvine Hall

  1. State your academic status/year: ______
  2. Room Type Preference : Single ⃝LRH Single ⃝GAH & Irvine

Double ⃝ GAH & Irvine

  1. Is this your final year? ⃝ Yes⃝ No
  1. Who will be responsible for the payment of the rental? ⃝ Sponsor ⃝ Parent ⃝ Self
  2. Please provide evidence by way of a letter from the sponsor or parent confirming their commitment to pay. (Parent may be asked to provide evidence of income)
  3. Information on Sponsor or Parent:-

.Name:______Relationship:______

Telephone Number: _H.______Cell.______Email Address______

Home Address:______

  1. Employer:______

Address:______

Telephone # ______Email Address:______

# of years employed:______Contact person:______

(Letter from employer confirming employment and proof of income should be attached)

If Self-Employed, please advise:______

SUMMARY OF MONTHLY INCOME AND EXPENDITURE

NET DRAWINGS OR SALARY / $ / RENT / $
INCOME FROM: REAL ESTATE / $ / BANK LOANS/CREDIT CARD/MTGE Etc. PAYMENT / $
BONUS AND COMMISSIONS / $ / $
DIVIDENDS / $ / LIFE INSURANCE PREMIUMS / $
OTHER SOURCES / $ / UTILITIES / $
$ / OTHER LIVING EXPENSES / $
$ / TOTAL / $
TOTAL / $ / NET DISPOSABLE INCOME / $

Section C – Emergency Contact Persons (2)

Name:______Relationship:______

Telephone Number: _H.______Cell:______Email Address ______

Home Address:______

Name:______Relationship:______

Telephone Number: H.______Cell:______Email Address ______

Home Address:______

Section D

  1. Kindly indicate if you have any health issues:

□ Asthma

□ Epilepsy

□Any physical impairment

□Allergies, hay fever

2. Please provide a valid identification

The undersigned hereby certifies that all information provided in this application is true, complete and correct and acknowledges that such information will be used by 138SL to determine the undersigned’s creditworthiness. Moreover, it is expressly agreed that any considerations to the undersigned are made by 138SL in reliance on the information disclosed in this application.

I understand and agree that:

  1. Application to 138SL does not guarantee a room.
  2. The University’s and 138SL regulation on conduct and policies under which housing facilities are operated must be observed at all times during the period of residence.
  3. It is my responsibility to update my contact information.
  4. If I fail to respond to any correspondence from 138SL by the stated deadline my application will be cancelled.

Persons who have been offered and accepted a place in 138SL will be guaranteed accommodation for 9 months or 51 weeks, provided that all terms and conditions of the Hall Agreement are adhered to.

Signature / Date