Student Form

First Name(s) (in entirety as shown in passport)*

Please fill out this field.

Last Name(s) (in entirety as shown in passport)*

Please fill out this field.

Nationality*

Please fill out this field.

Phone Number*

Please fill out this field.

Student Email*

Please fill out this field.

Board Type*

Please fill out this field.

Private Bathroom(Additional charges will apply)*

Yes
No

Please fill out this field.

Ok with cats*

Yes
No

Please fill out this field.

Ok with dogs*

Yes
No

Please fill out this field.

Medical Condition (requires custodian to help visit a physician regularly)

Yes, I have a medical condition

If you have any special requests such as dietary restrictions and/or if you have any allergies, please indicate here.
Also if you are going to share the same room with another student and/or if you want to be placed in the same house with another student,
please indicate that student's full name here:

Please enter information for the arrival flight below*

I don't know the flight info yet

Airline Company

Please fill out this field.

Flight Number

Please fill out this field.

Arrival Time

Please fill out this field.

Please enter information for the departure flight below*

I don't know the flight info yet

Airline Company

Please fill out this field.

Flight Number

Please fill out this field.

Departure Time

Please fill out this field.

Used to collect information needed for the IMM5646 Custodianship Declaration form.

At least one parent / guardian phone number must be associated with a WhatsApp account.

Parent / Guardian 1

Relationship

Family name

Given name(s)

Date of birth

Phone number

Home address: street and number

City

Region / Province / State

Postal code

Country

Parent / Guardian 2

There is no second Parent / Guardian

Relationship

Family name

Given name(s)

Date of birth

Phone number

Home address: street and number

City

Region / Province / State

Postal code

Country

Drag files onto a row or use the buttons · PDF, JPG or PNG · maximum 20 MB per file · saved with the form · guest total: up to 13 uploads / 100 MB

Registering a student on this portal does not guarantee a placement unless a placement is made by us. Please do not make any payments before you receive an invoice from us.

Student Form

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