Hillel House Cardiff

 

                                                                                              

            

 

 

 

                            


                                                                                          89 Crwys Road

                                                                 Cathays

                                                                  Cardiff

                                                                CF24 4NF

                                                                                           Tel; 029 2023 111

 

                                                                          APPLICATION FOR ACCOMODATION

 

                                                                           PLEASE WRITE IN BLOCK CAPITALS

 

SURNAME                                      OTHER NAMES                                 SEX

 

 

HOME ADDRESS                                                     TELEPHONE NUMBER

    (inc postcode)                                                               (inc STD Code)

                                                              

                                                                 

                                                                                        MOBILE NUMBER

 

 

DATE OF BIRTH                           NATIONALITY                         RELIGION

 

 

MARITAL STATUS                                                           NO. OF CHILDREN

 

 

 

NEXT OF KIN

 

NAME                                                                        RELATIONSHIP TO YOU

 

                                                                 HOME

 ADDRESS                                         TELEPHONE                              MOBILE                                                                                                    

 

 

 

 

 
NAME OF PARENTSí SHUL

 

 

(2)

MEMBERSHIP OF YOUTH GROUPS
 

 

 

------------------------------------------------------------------------------------------------------

PLACES OF SECONDARY EDUCATION

 

 

 

-----------------------------------------------------------------------------------------------------

 

NAME AND ADDRESS OF                                              PROPOSED COURSE

INSTITUTION TO WHICH                                                      OF STUDY

YOU HAVE APPLIED

 

 

 

 

 

DATE OF START OF COURSE                                          YEAR OF STUDY

 

 

DO YOU HAVE A CONFIRMED OFFER OF A PLACE ON THE COURSE TO WHICH YOU HAVE APPLIED?   YES / NO           

 

 (IF NO, PLEASE GIVE DETAILS)

 

 

-----------------------------------------------------------------------------------------------------

FROM WHAT DATE DO YOU INTEND TO COMMENCE YOUR STAY AT HILLEL HOUSE, CARDIFF?

 

 

 

SPECIAL REQUIREMENTS

(eg Physical Disablement etc)

 

 

DIETARY REQUIREMENTS (Please circle)

 

  Vegetarian / Vegan / Diabetic / Kosher

 

  Level of Kashrut  (please give details)

 

 

 

 

NUMBER OF PERSONS FOR WHOM ACCOMODATION IS REQUIRED

 

(3)

 

PLEASE STATE WHY YOU WOULD LIKE TO LIVE IN HILLEL HOUSE, CARDIFF

 

 

 

 

 

 

 

 

 

 

(Note, this information may be considered in the event of over-subscription for places)

 

 

PLEASE GIVE THE NAME AND ADDRRESS OF TWO REFEREES

 

(1)

 

 

 

 

 

(2)

 

 

 

 

 

-----------------------------------------------------------------------------------------------------

SIGNATURE                                                        DATE

 

PLEASE NOTE THAT ONLY FULLY COMPLETED APPLICATION FORMS CAN BE CONSIDERED. PLEASE COMPLETE  ALL THE SECTIONS

 

PLEASE RETURN COMPLETED APPLICATION FORM TO;

 

                     MRS LISA GERSON                         lisa@gersonfamily.freeserve.co.uk