Short Term Accommodation Application Form

Applicant Contact Details
Family Name:
Given Name(s)
Preferred Name:
Title:
Gender: Male Female
Date of Birth : DD/MM/YYYY
Contact Home Address
Address 1:
Address 2:
City:
Province / State:
Postal Code / ZIP :
Country:
Telephone:
Mobile:
Email:
Alternate Email:
Special Requirements
Please answer the following questions in order for Education City to provide you with the most appropriate accommodation to suit your needs. All information provided will be treated as confidential.
Date of Arrival:
Estimated Time
of Arrival:
Date of Departure:
Number of Nights:

How did you hear about the Education City Residential Village?
 I certify that the information contained in this application is complete and accurate
 I agree for my Personal Information to be given to USQ Springfield for the Setup of Internet Quotes
*Please place a tick in the box so when it is clicked on, it appears.