<p>Asha House / Stanton Asset Management Application form 2013/ 2014</p><p>Please complete all the fields clearly. All fields marked with * are mandatory</p><p>Accommodation Type of accommodation*: Are you a re-booker? Yes No </p><p>About you * Your first name * Other name(s) * Your last name * Your gender Male Female * Your date of birth / / * Your national insurance number </p><p>* Your mobile tel. no (inc. country code) ( ) * Your home tel. number (inc. country code) ( ) * Your email address * Your home address </p><p>* Postcode </p><p>Your Guarantor Next of Kin (tick here if same as Guarantor) * * Relationship to you * First name * Last name </p><p>* Email address </p><p>* Home address * Postcode </p><p>Health & Safety * Do you have a disability or medical condition which we need to be aware of? Yes No If yes please provide details </p><p>Next of Kin (tick here if same as Guarantor) * * Relationship to you * First name * Last name </p><p>* Email address </p><p>* Home address * Postcode About Your Requirements Are you booking as an individual or part of a group? Individual Group Preferred Block/ Apartment/ Room Number Preferred Floor High Low If you are part of a group, please state the names and room numbers (if known) of the students you would like to live with: Name Block/ Apartment/ Room Number Name Block/ Apartment/ Room Number Name Block/ Apartment/ Room Number Name Block/ Apartment/ Room Number Name Block/ Apartment/ Room Number </p><p>Do you want to live in a single or mixed sex apartment? Single sex Mixed sex Are you an international Student? (If yes, your home country?) Additional information you would like us to take into consideration when allocating you a room. </p><p>About your studies * Where will you be attending? UCAS number (1st Year Undergraduates) What are you studying? What year are you currently studying? How did you learn about Asha House? </p><p>Choosing How to Pay How would you like to pay your booking fee? * Cheque Debit Card Credit Card </p><p>Rooms are booked on a first come first serve basis, so please make sure you have made arrangements to pay your booking fee’s ASAP to make sure you have secured your room</p><p>Signature * Date * / / ______</p>