Queen’s Accommodation and Hospitality

Elms Village
Queen’s University Belfast
78 Malone Road, Belfast BT9 5BW
Tel: 028 9097 4403
Fax: 028 9097 4489
Email: accommodation@qub.ac.uk
Web: www.stayatqueens.com
APPLICATION FOR ACCOMMODATION – RESIDENTIAL YEAR 2009-2010
TO BE ACCOMPANIED BY A £300 B00KING DEPOSIT PAYABLE BY CHEQUE OR DEBIT / CREDIT CARD
Accommodation will be allocated from 24/08/09. To ensure that your application is considered in the 1 st round of allocations
you must return completed forms by 24/08/09. We will allocate rooms for applications received after this date but you may not
receive your 1st choice of accommodation.
Personal Details
UCAS


Personal ID Student Status UG  Returning 
or QUB  Please tick the
Student appropriate box
PG  Mature 
Returning students please provide your QUB Student number (over 21 yrs)
Number
Title Mr/Ms/Mrs/Dr (delete as appropriate) Male  Female  Date of Birth dd/mm/yyyy
Surname

Forename(s)
Email
address
Please print ___________________________________________@______________________________________(
clearly if returning to Queen’s University use your QUB email address)
NB. We will use the email address you provide as the SOLE means to offer you an accommodation place. Ensure it is entered accurately. You will
receive an acknowledgment of your application by email. You are advised to add our email address accommodation@qub.ac.uk to your address book
and check that this email address is known to your spam handling software. Successful accommodation applicants will receive an offer of
accommodation by email on or after 24/08/2009.
In case of Name :
Home Emergency we
require a Contact
Address
and Address
details
Relationship to you:

Postcode Postcode Telephone

Telephone (Including code) Arrival Date dd/mm/yyyy (if before 19/09/2009)
Mobile Country of Origin
Details of your study  Please tick the appropriate boxes below

Which College do you attend?  QUB  StranmillisSt Mary’s UUJ Belfast Metropolitan College 
Please tick the appropriate box

Year of Study yyyy/yyyy Course

If you will be enrolled at Queen’s or other university college
for less than the full year please give the precise duration
of your course
Disabilities or medical conditions
Have you any medical condition /recurrent illness which
should be considered when being allocated a room, e.g.
fear of heights, inability to climb stairs etc
How you intend paying for your accommodation
Payment in full by Cheque
(Please make cheques payable to Queen’s University Belfast)
Direct Debit Instalments
3 instalments collected on 01/11/2009, 01/02/2010 and 01/05/2010 OR
7 monthly instalments collected from 01/11/2009 to 01/05/2010
From d d / m m / y y y y To d d / m m / y y y y
 Please tick the appropriate box
If YES, please attach details or, if you wish to discuss
the matter in confidence, contact the Elms Village
Yes  Reception Telephone 028 9097 4403 email
accommodation@qub.ac.uk
No  For Special Needs assessment ensure you contact
Disability Services Telephone 028 9097 3225 email
disability.office@qub.ac.uk
 Please select one of the following options below
We will send you an invoice with your offer of
 accommodation, your payment must be received on or
before 19/09/2009.
We will send you a direct debit form with your offer of
accommodation. Your Direct Debit form must be returned
 on or before 19/09/2009. You must have a UK bank
account that accepts direct debit payments. Direct Debits
 cannot be collected from savings accounts.

Cheque, Credit / Debit Card or Cash (option only available to
international students)
First payment due on or before 01/11/2009 followed by two payments made by
direct debit due on or before 01/02/2010 and 01/05/2010.
Salary Deduction (Postgraduates receiving a Queen’s University salary only)
We will send you an invoice with your offer of
accommodation. Present your invoice with your first
 payment in person at Elms Village Reception. You will
then make two direct debit payments.
We will send you a salary deduction form with your offer
 of accommodation. Your salary deduction form must be
returned on or before 19/09/2009.
Your Accommodation preference
Please state the order of your preferences in the boxes below (1, 2, 3 etc) ONLY STATE A
Undergraduate PREFERENCE FOR THE TYPES OF ACCOMMODATION YOU WOULD DEFINITELY ACCEPT IF
Accommodation OFFERED – see Accommodation Breakdown attached for further information
Contracts Short Term
38 Week Contract 50 Week Contract
Available Contract Only
Elms Village Elms Village Purpose Built Houses Other Houses Elms Village
Grant House
26-30, 36-
(Preference 7,8,9,12
Elms Village Elms Village 40, 46-50 76 Malone Elms Village
given to College
Apartments Apartments Mount Road Apartments
International Gardens
Charles
Students)
Single
Standard  N
 N
 N
 N
   N

Single En suite  N
 N
 N

Large Single1  N
 
N 1
Networked NB. There are a limited number of large rooms available

Please state the order of your preferences in the boxes below (1, 2, 3 etc) ONLY STATE A
Postgraduate PREFERENCE FOR THE TYPES OF ACCOMMODATION YOU WOULD DEFINITELY ACCEPT IF
Accommodation OFFERED – see Accommodation Breakdown attached for further information
Contracts Available 38 Week Contract 50 Week Contract
Purpose Built
Elms Village Purpose Built Houses Elms Village
Houses
Location
32,34,42,44 Mount
Elms Village Guthrie House Elms Village 11-19 Mount Charles
Charles
Single Standard  N
 N
 N
 N
 N

Single En suite  N
 N

Large Single2  N
 N

Large Single Ensuite3  N

N 2 3
Networked There are a limited number of large rooms available Large en suite rooms are equipped with baths.

Special Requests  Please tick the appropriate box

Bedding Packs (we do not supply bed linen – you can purchase a new linen pack from us at a cost
of £30 – it will include a duvet, duvet cover, pillow, pillow case, under sheet and over sheet) Yes  No 
ACCOMMODATION FOR COUPLES/FAMILIES
Please note there is limited accommodation for couples or families in University residences. Anyone interested in this type of accommodation should contact Elms
Village Reception, 78 Malone Road, Belfast. Telephone 028 9097 4403 email accommodation@qub.ac.uk
CAR PARKING – QUB STUDENTS ONLY
Due to the traffic congestion in South Belfast and around QUB the University actively discourages students from bringing cars to Belfast. If the use of a car is
necessary students are requested to apply for car parking which is £84.00 for the full residential year (38 or 50 week contract; fee subject to change). Please
complete the Car Parking request form and return it with your application. Car Parking is limited and there is no guarantee you will receive a car parking space.
Additional forms are available from www.stayatqueens.com
BICYCLES AND MOTOR BIKES
We provide bicycle stands outside each apartment at the Elms Village. Motor bikes can be parked in some areas of Elms Village. All forms of transport are parked
at the owner’s risk.
RESIDENTIAL ACCOMMODATION YEAR
Students who are applying for a place in University residences are reminded that the fees are payable for the full period of residence as stated in the appropriate
accommodation contract, and as such, students will be liable for the full fees. See ‘Conditions of Occupancy for more information’.

Check List  If paying your deposit by cheque, put your name, UCAS OR QUB Student number on the back of the deposit cheque

Application form  £300 Booking Deposit  Postgraduate payment form 

(Please make cheques payable to Queen’s University Belfast) (if applicable)

Group booking form  Car parking request form  Is your email address correct? 
(if applicable) (if applicable)
We will use the email address you provide as the sole means to offer you an accommodation place. You are advised to add our email address
accommodation@qub.ac.uk to your address book and check that this email address is known to your spam handling software. If successful, you will
receive an offer of accommodation by email on or after 24/08/2009.
DECLARATION: I understand that if admitted to accommodation arranged through Accommodation and Hospitality I agree to pay the appropriate fees and
charges. I also understand that I will not be entitled to a refund of my booking deposit if accepted to Queen’s University and I decline an offer of
accommodation, even if Queen’s is not my first choice university. I understand that this information will be used in the administrative process and procedures
associated with the provision of an accommodation service by Queen’s University Belfast. I understand that the residential fees are payable for the full period of
residence as stated in the appropriate accommodation contract and that no refunds including the booking deposit are available in the event of early termination
of the residential contract.
I understand that the information on this application form will be used to update my University records and will be held for up to 3 years after the end of my
accommodation contract providing there are no outstanding account queries or issues. During this period the information may be made available to relevant
University staff and management. The University Management reserves the right to pass the information on to a third party agency for the collection of outstanding
debt. Management will discuss and/or provide details of your residential fees account with your parent or guardian; if you do NOT wish us to discuss these details
with your parent of guardian please inform us in writing.

Signed Date