Shared Accommodation Enquiry Form

Accommodation Enquiry Form

Welcome to our Health Service!

This form is for Clinical Placement Students and Staff of Robinvale District Health Services requiring short term accomodation.
Campus
Please choose:
Full Name

First NameLast Name
E-mail
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
DEPARTMENT:
i.e Physiotherapy, Nursing
Type of Stay:
Arrival Date

DayMonthYear
Departure Date

DayMonthYear
Time of Arrival

Hour Minutes

AM/PM Option
NB;

Key Collection - arrival outside of business hours (8:30am-5:00pm Monday-Friday) require alternate arrangements.
Linen Required (bed linen/towels):
Payment via:
General comment about your enquiry:
Once your enquiry form has been received, we will contact you shortly after.

Accommodation is subject to availability and is approved once an Accommodation Agreement has been signed.
Should be Empty:

Accommodation Enquiry Form