Application Form - Student Village

ACADEMIC YEAR 21/22

We are now taking bookings for

1st, 2nd, 3rd, 4th years

Student Details
First Name*
Last Name*
Gender*
Male
Female
Date of Birth*
Date Format: DD slash MM slash YYYY

Nationality*
Home Address*
Email*

Home Phone Number
Mobile Number*
Parent / Guardian
Name / Surname*
Mobile Number*
UCC Course Details
UCC Course*
Year*
Previous Landlord
Previous Address
Landlords Name
Landlords Phone Number
Accomodation Preferences
Please note that not all preferences are guaranteed on type of room and location
Room Type*
Standard Room
Ensuite Room Double Bed
Car Parking
Yes
No
Make / Model
Reg Number
Health
Please specify in brief details of any illness from which you may suffer
Where did you hear of us?
Notes
Terms & Condition*
I agree to terms
Terms & Condition