Date of Application *

When I would like to move in

Full Name (Title, Given Name, Middle Name, Surname) *

Nationality *

Gender * MaleFemaleOther

Place of Birth *

Date of Birth (dd/mm/yyyy) *

Home Address *

Suburb *

State *

Postcode *

Address for correspondance (if different from above)

E-Mail Address *

Primary Phone Number *

Parent/Next of Kin (Full Name) *

Relationship to you *

Contact Number *

Proposed/Current University Course *

Name of Tertiary Institution *

Tertiary Year Level (if applicable)

Name of Secondary Education Institution *

Years Attended *

Certification (e.g. HSC, IB, etc.) *

Who will pay your rent? * SelfParentsOther

If Other, please specify

Name of person who is paying

Are you currently working? * YesNo

If yes... * Full-timePart-timeCasual

List other work experience you have done in the past, include when and for how long. *

Which clubs, organisations, societies, churches, charities, or community groups have you been involved with? *

What are your interests/hobbies? *

What is your intended profession or career? *

Why have you chosen it? *

What books, other than for academic purposes have you read in the past 6 months? *

What qualities do you think you could contribute to the environment and life at Hope Uniting Church? *

How do you think living at Corio Student House could benefit you? *

Are there any particular matters, such as medical conditions, dietary restrictions, etc., which you think the church ought to know about? (Note: should there be a matter of a sensitive nature, you may raise it at your interview.)