Please Complete This from and Return to Northampton Student Lets Office Or E Mail To
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
Nationality and Residence details
NationalityCountry 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?
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)
Course details
What course are you on?How long will this course run for?
Student ID Number
Campus :
When is your start date
Entry point
Have you been suspended or removed from Halls in the past
If yes, please give details
Property details
Address of property you wish to rentPost Code / Names of students wishing to rent with you
Previous housing history
Have you rented or owned your own home in the last 5 years?If yes, please provide details of addresses for the last 5 years
Have you been evicted in the last 5 years?
If yes, please give details
Have you been convicted of a criminal offence in the last 5 years?
If Yes, please give details
Do you have any medical conditions that we should be aware of?
If Yes, please give details
Compton House
What floor is your preference? Please select 2 options and mark with 1 for 1st preference and 2 for your 2nd preference.Lower ground Floor Level
Ground Floor Mezzanine Level
Upper Ground Floor Level / First Floor Level
Third Floor Level
Second Floor Level
Third Floor Level
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
WhiteEnglish □ 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
Other ethnic group
Arab □ Prefer not to say □
Any other ethnic group please state: /
Sexual orientation
Your religion
Age group
18 – 20□