138 Student Living

UWI, Mona Campus

Hall of Residence Application Form - 2018/2019 Academic Year
Form must be completed and submitted by email to: info@138studentliving.com
A passport size picture will be required on acceptance of a room on 138 Student Living
Section A

ID: Faculty: DOB:

First
Last Name:
Name: Middle Name:

Email Address: Telephone No: TRN:

Nationality: Gender:

Address (Home):

Section B

1. Are you a new or returning student? ⃝New ⃝Returning

2. Have you previously lived on Hall? ⃝ Yes ⃝ No
If answer is yes please state which hall ________________________________.
3. Please state floor preference 1st , 2nd, 3rd, 4th, 5th, 6th
4. Indicate your Hall Preference: Leslie Robinson Hall, George Alleyene Hall,
Irvine Hall
5. State your academic status/year: ________________________________________
6. Room Type Preference : Single ⃝ LRH Single ⃝ GAH & Irvine
Double ⃝ GAH & Irvine
7. Is this your final year? ⃝ Yes ⃝ No

8. Who will be responsible for the payment of the rental? ⃝ Sponsor ⃝ Parent ⃝ Self
9. Please provide evidence by way of a letter from the sponsor or parent confirming their
commitment to pay. (Parent may be asked to provide evidence of income)
10. Information on Sponsor or Parent:-
. Name:_______________________________________Relationship:_______________________

Telephone Number: _H._______________Cell._______________Email Address ____________________

Home Address:________________________________________________________________________
11. Employer:____________________________________________________________________
Address:_____________________________________________________________________
Telephone # _________________________Email Address:_________________________
# of years employed:__________Contact person:____________________
(Letter from employer confirming employment and proof of income should be attached)
If Self-Employed, please advise:___________________________________________________
SUMMARY OF MONTHLY INCOME AND EXPENDITURE
NET DRAWINGS OR SALARY $ RENT $

INCOME FROM: REAL ESTATE $ BANK LOANS/CREDIT CARD/MTGE Etc. PAYMENT $

BONUS AND COMMISSIONS $ $

DIVIDENDS $ LIFE INSURANCE PREMIUMS $

OTHER SOURCES $ UTILITIES $

$ OTHER LIVING EXPENSES $

$ TOTAL $

TOTAL $ NET DISPOSABLE INCOME $

 Section C – Emergency Contact Persons (2)

Name:_______________________________________Relationship:________________________
Telephone Number: _H._______________Cell:_________________Email Address __________________
Home Address:________________________________________________________________________

Name:_______________________________________Relationship:________________________
Telephone Number: H.________________Cell:_________________Email Address __________________
Home Address:________________________________________________________________________

Section D
1. Kindly indicate if you have any health issues:
□ Asthma
□ Epilepsy
□ Any physical impairment
□ Allergies, hay fever
2. Please provide a valid identification
The undersigned hereby certifies that all information provided in this application is true, complete and
correct and acknowledges that such information will be used by 138SL to determine the undersigned’s
creditworthiness. Moreover, it is expressly agreed that any considerations to the undersigned are made
by 138SL in reliance on the information disclosed in this application.
I understand and agree that:
1. Application to 138SL does not guarantee a room.
2. The University’s and 138SL regulation on conduct and policies under which housing facilities
are operated must be observed at all times during the period of residence.
3. It is my responsibility to update my contact information.
4. If I fail to respond to any correspondence from 138SL by the stated deadline my application
will be cancelled.
Persons who have been offered and accepted a place in 138SL will be guaranteed accommodation for
9 months or 51 weeks, provided that all terms and conditions of the Hall Agreement are adhered to.

Signature Date