1. Personal Details

2. Further Details

Surname/Family name

学生的姓

I.D. number(University Number)

学生申请号（在入学通知书上有）

First/given name(s)

学生的名

Correspondence address

Room 1208, Summit Centre,

1088 Yan-An Rd. West,

Shanghai, 200052

Country: P. R. China

Postcode ( UK )

Home address (if different from correspondence address)

学生的家庭地址

Country: P. R. China

Postcode ( UK )

Your age on 1 Septmber 2003 学生实际年龄 years

Contact in case of emergency:

Name 紧急联系人的姓名

Date fo birth(DD/MM/YY) 学生的生日 , 按日 / 月 / 年写

Male (M) / Female (F) 学生的性别

Contact telephone number 其电话号码

Main contact number (including are code)

Tel. Mobile

e-mail

主要联系人的电话号码，手机号码， e-mail 地址

Is this your first year at university of Hertfordshire

Yes R No □

If no, please state when first attended

3 Course Details

Title of course 课程名称

Is your offer of a place at University of Hertfordshire conditional on exam results? Yes □ No R

Are you: Home(UK) □ E.U. □ International R

Will you be attending the overseas orientation programme?                   Yes R No □

4. For completion by ERASMUS, NON-UK EXCHANGE & STUDY ABROAD STUDENTS ONLY

University of Hertfordshire programme co-ordinator                    Tel:

Home University or College                                          Tel;

What is your period of study?   Semester A ＊   □   Semester B ＊ □    Full year □

＊ Student studying for less than one year are not eligible for accommodation within University Residences

5. Allocation Details

Please indicate below your preferred areas of accommodation, giving your first, second, third and fourth choices; describe the type of accommodation and the Band in the spaces provided.

De havilland campus band AA=Flat ＊ , College Lane campus Band A=Flat and House, Band B=Traditional halls, Band D=Double rooms. Approximate weeklt lisence ranges from ￡ 51 to ￡ 80

＊ NB    Smoking is not permitted at de Havilland campus

         Cars are not permitted at de Havilland campus

Please note: this indicates your preferences only; whilst all efforts will be made to allocate you to your preferred accommodation, this may not always be possible.

A limited number of halls at de Havilland campus will be used for conferences during the Easter vacation. Students living in these halls will be required to vacate and will receive a refund of the licence fee for this period. Please indicate by ticking the box if you would prefer an allocation into one of these halls and would be able to make your own accommodation arrangements for the Easter Vacation                                                            □

There is a very limited amount of single sex accommodation within Flats and House.        □

Please indicate if, for religious/culture reasons, you would prefer single sex accommodation

Is there anyone coming to the University of Hertfordshire with whom you would wish to share a room( 如果申请双人间的学生可以要求与某一位同学合住 )

Name                                         Course

Do you intend to bring a car?            Yes □                 No □

Make                                       Registration

Please indicate any special circumstances you wish to taken into consideration if you ar allocate a place eg: religious/cultural background, health etc. For students with additional needs this must include any adaptations to accommodation which may be necessary . The university operates a policy of no smoking for communal areas; smoking is currently permitted in individual rooms at the College Lane campus. Smoking is not permitted at the de Havilland campus

All efforts will be made to comply with requests but no guarantees can be given.

6. Lodgings-with a resident landlord/lady(This section should be completed even if you have applied for University Residence)

7 day lodging R 5 days lodging   □   Full board □   Self-catering  R   Vegetarian  □

7. Statement and Declaration

Is there anything you wish to add to this application that we have not asked?

学生的特别要求。

I declare the information provided to be correct

Signature 学生签名                                  Date  日期