ASC Residences Application Form for 2013

* indicates minimum required information

ASC Residences Application Form for 2013

Applicant details

*Gender:
  •  
  •  

(d/m/yr)

(d/m/yr)
*Do you have a different mailing address?
  •  
  •  

(If different from above)
*Are you an International Student?
  •  
  •  

(If Yes)

(if Yes)

(d/m/yr)

(not required for Australian Citizens; permanent residents)

(d/m/yr)

(d/m/yr)

Next of kin (Parent or Guardian)

Personal

Please provide details of any medical, allergic, dietary, or disability conditions or any other information that the ASC should be aware of as the accommodation provider:

List any major illnesses or surgery occurring in the last 12 months:

List any medication required to be takend on an ongoing basis:

Please note this information may be provided to emergency staff in the event of an emergency.

Fee Options

*Please choose fee option:
View Fee Schedule
*Method of Payment

Educational Enrolment Details

Security Declaration

Police Clearance (purpose code #28): Long term residents staying at the ASC Residences require this clearance.

We have attached the Police Clearance Form and we will process this for you at our own cost.

Although we require receiving occupancy fees as part of the process to confirm your application, final approval of your application will be subject to our obtaining a Police Clearance Certificate. Residency may be revoked per termination clauses in the event clearance is not provided by the Australian Federal Police.

Character Reference

Please provide a written statement from a personal referee to support this application. Please limit the statement to an A4 page. Maximum file size limit is 2Mb. Accepted file types are doc, docx and pdf

*Name of referee:
*Email:
Address:

Additional Documentation

In addition to submitting this application form, please upload the following documents. Maximum file size limit for each document is 2Mb. Accepted file types are jpg, pdf, doc, docx, png and gif

Personal Declaration

By activating the "SUBMIT" button, I confirm and declare the information I have supplied on this form is to the best of my knowledge and understanding complete, correct and truthful. I authorise ASC to obtain further information with respect to my application through my references and the educational institution I will be/am attending.

Please note there is no save in progress feature on this form.

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