Hall of Residence Short Term Accommodation Form

THE UNIVERSITY OF THE WEST INDIES

ST. AUGUSTINE, TRINIDAD AND TOBAGO, WEST INDIES

Halls of Residence

Telephone: (868) 663-0075

SHORT TERM APPLICATION FORM
SHORT TERM APPLICATION FORM
SURNAME
FIRST NAME
Are you a UWI Student

YesNo
UWI Registration No/ National ID No
Address

Street Address

Street Address Line 2

CityState / Province

CountryCountry
Date of Birth

DayMonthYear
Date
TELEPHONE

Country CodeArea CodePhone Number
EMAIL
example@example.com
Sex

MaleFemale
Do you have any known medical ailments/ allergies?

YesNo
Medical
Hall of Residence
Room Type
Arrival Date

DayMonthYear
Date
Departure Date

DayMonthYear
Date
Person to be contacted in case of an emergency:
NAME
RELATIONSHIP TO APPLICANT
Home/Office Telephone
Mobile
Email
example@example.com
This documentation would be handled confidentially. The University of the West Indies reserves the right to determine who is permitted to stay on hall based on the information given. This is to ensure that the safety and welfare of the students are not jeopardized and that the applicant is eligible for on- campus accommodation.
Photo
DATE

MonthDayYear
Date
SIGNATURE

Clear
Should be Empty: