Domestic Student Accommodation Application Form Britannia Park - WelTec International A Contact Details The following questions give us basic information about your and your family. These will be used primarily in emergency situations. Given Name/s Surname/Family Name Male Female Date of Birth WelTec ID Number (if known) Permanent Home Phone Number ( ) Fax number ( ) Mobile number ( ) Email Current or preferred address for notification of application (if different from above) In an emergency, relative or friend to be contacted: Name Relationship Phone number ( ) Which ethnic group do your identify with? (eg, Asian, African, Polyesian) 24/02/09 1
B Additional Information The following questions help us understand your accommodation needs What is your programme of study? (eg Degree, Diploma, Certificate, English) C Accommodation Britannia Park, Petone, Wellington $160 per room per week (The discount rate of $160.00 per room per week will apply as long as payments are made in accordance with Clause 1 of the tenancy agreement, with the first payment starting on the commencement date. Any late payments shall be at the full rate of $180.00 per week.) Managed units with single room accommodation. Some shared rooms available. Each bedroom has a large bed, desk, chair, wardrobe as well as a telephone line connection. Pillow, duvet and linen provided. Each apartment has separate toilet and bathroom facilities and a well appointed kitchen. No meals provided. The facility is only 5 minutes walk from the main Petone Campus and was opened in 2004. Vehicle parking space available. DEPOSIT A deposit of $320 in advance is required to secure a room within the complex. * This deposit covers a rental bond ($320). * ACCOMMODATION REQUIREMENTS Accommodation, which is specifically: Single sex Mixed No Preference Accommodation of a specifically cultural, ethnic or religious background Yes No No Preference If yes, please give details Accommodation is NON SMOKING 24/02/09 2
Are there any other factors you wish us to consider in the allocation of a place (eg a request to be with particular friends) Yes No If yes, please give details As we are interested in your health and safety, we need to know the following details. Do you have: Significant visual disability Significant hearing disability Epilepsy Any drug allergy asthma diabetes movement disability any other disability Please give details D Interests School/Community responsibilities Personal/Cultural Sport and Recreation E Term of Stay From XX February 2007, (date dependent on programme start date) for the period of your programme of study. Programme of Study Dates NOTE: The only way that this lease can be broken is if your find a suitable replacement to take your place in the accommodation. Early notice will only be accepted due to medical conditions or withdrawal from the programme of study. 24/02/09 3
F Referees Please supply two referees (not family members) we can contact for a character reference should we need to. 1) Name Relationship Contact Phone Number 2) Name Relationship Contact Phone Number G Declaration Statement to be made by applicant I hereby apply for a place of residence at Britannia Park for the period of time indicated on this application. If admitted, I undertake to observe and abide by the General Regulations of the Wellington Institute of Technology and the Britannia Park Residential Accommodation Rules as outlined in the residential Tenancy Agreement in respect of Britannia Apartments, Petone. Administration Fees: A $200 fee will be charged if a student cancels before they move to Wellington or does not take up the accommodation provided. Signature: Date: The information provided in this application form will be used by WelTec and Britannia Park Student Accommodation Management Limited for the purposes of selecting students for residency. This information also enables WelTec to provide ongoing support and assistance to those who are residents of Britannia Park Accommodation. Please send your completed application form including two passport-sized photos to: Student Accommodation Officer WelTec Private Bag 39803 Lower Hutt 5045 (04) 920 2400 24/02/09 4
Procedure for Direct Deposit of Fees Students who wish to pay by a single bank may do so by asking the bank to deposit the required amount of money in the Student Accommodation Management Limited bank account Bank: National Bank Account Name: Student Accommodation Mgt Ltd Account Number: 06-0507-0051923-00 Please ask your bank to include sufficient text information with the deposit to enable us to identify your deposit from the bank statement. (eg Your name, date of birth, tuition and accommodation deposit) 24/02/09 5