APPLICATION FORM

I consent to my personal data being processed in accordance with the privacy policy of Heathfield (Norwich) Ltd. in relation to my application to live at Heathfield. (required)

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Please help us to process your application efficiently by checking that your responses are clear and complete.

Your first name (required)
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Your last name (required)
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Current address
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Home address (required)
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Your email address (required)
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Mobile phone number (required)
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Gender
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Date of birth (required)
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Studying at / Applying to (required)

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*Other - please specify
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(Please note that students studying at / applying to UEA and NUA will be given priority.)

Course title (required):
Course title
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Level of study in September 2021 (required)
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When will you need accommodation? (required)

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*Accommodation requirements if other than a standard contract:
Accommodation requirements
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Do you have any access requirements?
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*If Yes, please specify your access requirements. For example, would you prefer to be allocated a room in the flat reserved for women only?
Details
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If you have a car, you can book a parking space at Heathfield for GBP12 per month. Will you want to book a parking space?
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Period(s) I will need a car parking space:
dd/mm to dd/mm
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I came to visit Heathfield on

Select a date
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How did you hear about Heathfield Student Community Home?
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Tell us what you expect from living in a student community home, and what you think you would be able to bring to it. (required)
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Is there anything else you would like us to know?
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