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Title Mr Mrs Miss

First Name

Last Name

Date of Birth

Email

Phone Number

Mobile Phone

Your Nationality

Do you currently live in Australia? Yes No

Your Gender? Male Female

Street

Suburb/Town

State

ZIP/Post Code

Country

Australian students, please provide these details

Drivers License No.

License State

License Expiry

If you are not an Australian citizen, please provide:

Passport Number

Passport Expiry Date

Australian Visa Number

Visa Expiry Date

Course Name

Which Year? 1st Year 2nd Year 3rd Year 4th Year

Course Start Date

Course End Date

Name

Relationship

Email

Phone Number

Mobile Phone

Address

Same as current address?

If you have any medical conditions we should be aware of, please explain here. Include any disabilities.

Is there anything else we should know? Do you have questions, preferences, or requests?

I (name) give permission for Varsity Apartments to contact the University of the Sunshine Coast to ascertain my enrolment status.

Student ID Number