Student Application Form 1st September – 17th May
Atalia Student Residences Ltd. Corrib Village Accommodation


Personal Information
Title     Gender
First Name   Surname  
Date of Birth     Nationality  
CAO Number (Irish Only)   Program/Course  
Year   Home University  
PPS Number (Irish Only)     
Do you suffer from any relevant medical conditon i.e Asthma?    
 

 
Applicant Contact Information
 
Applicant E-mail   Applicant Mobile Phone   
Family/Home Address Current Address
(if different)
Street Address   Street Address  
City   City  
County   County  
Post Code   Post Code  
Country   Country  
Telephone   Telephone  

Guarantor's Contact Information Emergency Contact Details
(if different to Guarantor's )
Name   Name  
Telephone Number   Alternative Number  
Mobile No   Mobile No  

Accommodation Preferences
Please note: We have two different payment options - Click here for more details
 Booking Period    
 
Please Note:We try our best to give students their preference but this is not always possible.
Only select room types that you are willing to accept if 1st choice is not offered
1st Choice* - Apartments/Room Type          
2nd Choice* - Apartments/Room Type       
3rd Choice* - Apartments/Room Type       
4th Choice* - Apartments/Room Type       
5th Choice* - Apartments/Room Type       
6th Choice* - Apartments/Room Type       
7th Choice* - Apartments/Room Type       
Room Share
Please Note: We do not guarantee who your room mates will be.
Room Share1   Room Share 1 Std No
Room Share 2   Room Share 2 Std No
Room Share 3   Room Share 3 Std No
 
Additional Information

Bank Details (These are for refund purposes only)
Please note the transfers will take 3-5 working days to reach your account.
Bank Name   Bank Address 1  
Please indicate who the account holder is:   Name of Account Holder
Please indicate origin of the Bank
Bank Account Number    Bank Sort Code --      

If non-Irish A/C please specify the following(Transfers to Bank Accounts outside of Ireland will be subject to a banking charge deduction):
Bank IBAN Account Number Bank BIC Swift Code
I have read & understood the Licence Agreement.