First Name:

Surname:

Email Address:

Student Number:

Contact Number:

Which Bursary are you on for 2024?:

Do you prefer a Single Room/Sharing Room?:
SingleSharing

Are you Male or Female?:
MaleFemale

What is your planned arrival date?:
(eg. Feb 5th (we open from 8am on the 5th of Feb for 2024 arrivals))

Do you have any special requests or needs, as your well being is our priority?:
( If YES please state below, if none please leave field blank)

Please tick the box below to accept the Terms & Conditions (Required in order to submit application):