Student Application Form – 2017-2018

Please complete this from and return to Northampton Student lets office or e mail to

Northampton Student Lets, Northampton Students’ Union, Boughton Green Road, Northampton NN2 7AL

Please complete the form in BLOCK CAPITAL letters if hand written

Personal Details

Title (Mr/Mrs/Ms/Miss)
Surname/Family Name
First name(s)
Previous Name

Contact Details

Mobile Telephone (including international code)
Other contact number
E mail address
Permanent home address (if different from correspondence address)
City
Postcode
Country /

Correspondence address

(This address will be used for the correspondence address)
City
Postcode
Country

Emergency Contact Details

Next of Kin

Name :
Address:
Relationship:
Telephone numbers: 1 2
E mail address

Nationality and Residence details

Nationality
Country of Birth
Country of permanent residence
Who is expected to pay your tuition fees?
Do you need a visa to study in the UK?
(please complete below)
YES - Please provide your passport number
NO – and you are entering UK to study, under what tier will you enter the UK? / Have you previously been granted a visa to study
in the UK?
YES □ NO □
If YES please attach a copy of your visa to your application form

Applicants not born in the United Kingdom please state

Date of first entry into the UK
/ / (dd/mm/yy)
Date of most recent entry to the UK (Excluding holidays)
/ / (dd/mm/yy)

Data sharing

I consent to Northampton Student lets requesting information stored with the University of Northampton and any other landlord that I have been in connection with, that may be relevant to my tenancy. This may include but may not be restricted to:
  • Information regarding my behaviour within halls of residence
  • Any rent arrears with the University
  • Previous or impending disciplinary action
Print Name :
Sign:
Date:

How to rent guide

I have received a copy of the how to rent guide with this application form
Signed:
Print:
Date:

Course details

What course are you on?
Course Code:
How long will this course run for?
UCAS Number:
Student ID Number
Level : Undergraduate □ Postgraduate □
Campus : Park □ Avenue □
When is your start date
September 2017 □ January 2018 □ September 2018 □
Entry point Year 1 □ Year 2 □ Year 3 □
Have you been suspended or removed from Halls in the past Yes □ No □
If yes, please give details

Property details

Address of property you wish to rent
Post Code / Names of students wishing to rent with you
1
2
3
4
5
6

Previous housing history

Have you rented or owned your own home in the last 5 years?
Yes □ No □
If yes, please provide details of addresses for the last 5 years and the landlord contact details (telephone number / e mail address)
Have you any rent arrears with your current landlord or previous landlord?
Yes □ No □
Total of arrears £
Have you been evicted in the last 5 years?
Yes □ No □
If yes, please give details
Have you been convicted of a criminal offence in the last 5 years?
Yes □ No □
If Yes, please give details
Do you have any medical conditions that we should be aware of?
Yes □ No □
If Yes, please give details

Equal Opportunities Monitoring

All information is treated in the strictest confidence. This data is captured for monitoring purposes only. Whilst we encourage you to complete this form it is not compulsory for you to do so. Completion allows us to monitor our compliance with relevant equality legislation.

Your Ethnicity

White
English □ Welsh □ Scottish□
Northern Irish □ Irish □ British □
Gypsy or Irish Traveller □
Prefer not to say □
Any other white back ground please state:
Mixed / multiple ethnic groups
White and Black Caribbean □
White and Black African □ White and Asian □
Prefer not to say □
Any other mixed background please state:
Asian / Asian British
Indian □ Pakistani □Bangladeshi □
Chinese □ Prefer not to say □
Any other Asian background please state:
Black / African / Caribbean / Black British
African □ Caribbean □ Prefer not to say □
Any other Black/African/Caribbean background please state:
Other ethnic group
Arab □ Prefer not to say □
Any other ethnic group please state: / Male □ Female □prefer not to say □

Sexual orientation

Heterosexual □ Gay □
Lesbian □ Transgender □
Prefer not to say □Other, please state:

Your religion

No religion or belief □ Buddhist □
Christian □ Hindu□ Jewish□ Muslim □
Sikh □ Prefer not to say □
If other religion or belief please state:

Age group

18 – 20□ 21 – 25□ 26 –31 □
32 – 36 □ 37 + □