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Application for Accommodation at Highate Lodge.

To apply for a room at Highgate Lodge please complete the following form.

Family Name

Given Name
Date of Birth
(year)
Gender
Male Female
Home Address
Telephone Number (include country code)
Fax Number
Email Address
Where will you be studying in Adelaide
Which campus will you be studying at
What course are you studying
Date of Arrival
(year)
Exact Approx
How many semesters do you require the room for
Do you have a friend or relative living at Highgate Lodge, if so who
Have you previously inspected Highgate Lodge
 
If Yes, when
Are you a scholarship sponsored student
 
If “Yes”, what is the name of the sponsor
Are you an Education Agent filling out this on behalf of a client?  
if yes, Agent's Name
Agent's Email
Agent's Phone
Comments, Requests and Questions

IMPORTANT: Do not assume you have a reservation until you receive comfirmation from us.