Phone No (*)

Street Address (*)

City/Province/Region (*)

State (*)

Country (*)

Your Email (*)

Gender (*)
MaleFemale

Age (*)

Parents Guardians Name (*)

Parents Guardians Address (*)

Parents Guardians Phone No (*)

Do you smoke (*)
yesno

Would you prefer to stay with (*)
SmokerNon-SmokerDoesn't Matter

Would you prefer to stay with (*)
QuietSocialVery Social

Flatmates Preference (*)
All MaleAll FemaleMixed (both Male & Female)

Rate Yourself, from very quite to very social (*)
12345678910

Your religion

Prefer to Stay with as same as your religion
yesnodoes not matter

Lengh of stay (*)
1st Sem only (21th Jan - 14th July) 2nd Sem only (15th July - 31st Dec) Both (1st & 2nd Sem) (21st Jan - 31st Dec) 

Unlimited Broadband extra $10 per week (*)
yesno

Require Linen Pack? (*)
yesno

Require Car Park? (*)
yesno

Additional Information regarding flatmates you would prefer to stay with