On-modation Application Form 2014.doc

On-Campus modation Application Form 2014
Please fill in electronically
Please note that all students should return their modation form, including those choosing to live off-campus.
Personal Details
Reference No.(On your offer letter, start with 2 letters and followed by 6 digital numbers):
First Name:
Surname:
Gender:
Nationality:
. (dd/mm/yyyy):
Passport No.:
Telephone:
Mobile:
Email:
Address:
Expected Check-in Date:
(dd/mm/yyyy):
Level of study:
(If you are exchange/study abroad student) Your home university:
Emergency Contact Person
Name:
Relationship to applicant:
Telephone:
Mobile:
Choice of modation
(Please list your preference, with ‘1’ indicating your first preference, “3” as last.)
( ) Building 11 6,000RMB per semester/12,000RMB per year + 1000 RMB deposit
( ) Building 18 4,800RMB per semester/9,600RMB per year+ 1000 RMB deposit

( ) Building 20 2,900RMB per semester/5,800RMB per year+ 1000 RMB deposit

( ) I don’t need on campus modation
Students with disabilities / specific requirements:
To help us allocate the most appropriate modation, please indicate any special arrangements that you require (. assistance required, ground floor room, etc.)

I, , have read “The University of Nottingham Ningbo China Regulations for On-Campus Student Residences”(below) and agree to abide by all the stipulated rule