Accommodation Application Form
PERSONAL DETAILS
(*) OBLIGATORY FIELDS
Surname(s)(*): 
Name(*): 
Nationality: 
Sex:  MALE      FEMALE
Date of Birth(*):  (must be over 18)
Passport Number(*): 
Home Address: 
Post Code: 
City: 
Country: 
Telephone Number: 
Mobile Phone Number: 
Fax: 
Email(*): 
Reason for your stay at the UA: 
Course Dates in which you are registered(*): Start:     End: 
Promo Code:
If you are a Socrates/Erasmus student, please enter your User Name:(?) It is the User Name you got from the ERASMUS Office or Coordinator at your home University in order to register on-line with the Universidad de Alicante. For further information, please contact the ERASMUS Office or Coordinator.

Without username we cannot proceed with your application until it will be accepted.
Do you need a certificate of accommodation to obtain your visa?:    YES      NO

Please enter details of who to contact in the event of an emergency:
Name:
Telephone Nº:
Email:
ACCOMMODATION
ACCOMMODATION RESERVATION DATES
Date of arrival(*):     Le recordamos que debe solicitarlo 30 días antes de su llegada.
Para confirmar disponibilidad para antes de 30 días comuníquese directamente con aloj@csidiomas.ua.es.

Date of departure(*):   

PICK UP SERVICE
Do you require a pick up service from your point of arrival to your accommodation? YES NO

TYPE OF ACCOMMODATION REQUESTED
Please indicate your preference:
Accommodation in a shared flat
Family accommodation
University Halls of Residence (It is essential to ask about availability)
Sharing with:
(Please enter name and surname):
Observations:

PERSONAL PREFERENCES
YES
NO
Would you prefer to live with a non-smoking family?
Would you mind living with a family with small children?
Would you mind living with senior citizens?
Do you prefer a vegetarian diet?
Do you mind if there are pets in the house?
If there are any special circumstances which would require special consideration and/or would affect shared accommodation (for example, allergies, type of diet, medication, etc.), please give details:
Payment method

Payment does not guarantee availability.

IMPORTANT. PROCEDURE:

1.- Pay the reservation fee:
€85 administrative fee + €200 accommodation deposit = TOTAL €285

2.- For booking the pick-up service, you should pay:
€285 accommodation + €55 pick up = TOTAL €340

3.- Payment method:
Credit Card (Online) *American Express not accepted
Credit Cards

Bank Transfer:

    Account holder: Centro Superior de Idiomas de la Universidad de Alicante, S.A.U.
    Bank: Banco Santander
    Branch: Plaza de los Luceros, 1 03001 Alicante
    Current Account Number: 0049 6659 03 2816134203
    Swift Code: BSCHESMMXXX
    IBAN Code: ES4600496659032816134203
Important:
  • When making the bank transfer or payment, ensure that the following appears: “Accom. + Surname(s), Name (of student)”
  • Ensure that bank charges are met by the payer.

4.- Send the proof of payment by any of the following means:

E-mail: aloj@csidiomas.ua.es

Fax: +34 965 90 37 94

Postal service:
Universidad de Alicante.
Centro Superior de Idiomas
Servicio Alojamiento
Ctra. Alicante/San Vicente, s/n
E-03690 San Vicente - Alicante (España)

If the Accommodation Request Form is not sent on-line, a completed, signed paper copy may be sent to the postal address or fax number given above, together with the proof of payment.

By sending this Form, you agree to accept the terms and conditions contained herein, together with the specific terms and conditions corresponding to the type of accommodation in question.

You are advised to print out a copy of this form as proof of sending.

To verify that you are human, please enter the result of the following sum:
12 + 11 =

I have read and agree to the terms and conditions of the Data Protection Law  

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