Personal data

Surname*

Name*

Date of birth
(DD.MM.YYYY)*

Sex

female male

Marital Status

single
other?

Nationality

German
other?

Home address

Street name and street number*

Postal Code, City*

Phone*

Mail address*

Study address / care-of address

Street name and street number

Postal Code, City

Phone

Application

registration status

I am enrolled at the:

Universität Paderborn Katholische Fachhochschule Theologische Fakultät Fachhochschule der Wirtschaft

I am an applicant for a place at the University of Paderborn to the

  winter semester (october to march) summer semester (april to september)  in year 

a german language course participant

Did you ever apply for a flat / an abode in Paderborn?

No
Yes,for Peter-Hille-Weg 11 Peter-Hille-Weg 13 Vogeliusweg Mersinweg

No
Yes,for Peter-Hille-Weg 11 Peter-Hille-Weg 13 Vogeliusweg Mersinweg

Which accommodation do you apply for? You can only choose one. If you want to apply for a second accommodation, you have to file a second application.

Peter-Hille-Weg 11:

Single room Single flat Double flat

Peter-Hille-Weg 13:

Single room Double flat

Vogeliusweg:

Single room in 2 person flat share Single room in 4 person flat share Einzelapartment

Mersinweg:

Single flat

I would move into a shared flat with a person of the opposite sex:

Yes,for  
No  

I would like to rent the room starting with:

Monat January February March April May June July August September October November December     
in year

Please send me offers starting at the earliest in:

Monat January February March April May June July August September October November December     
in year

To which address is an rental offer to be sent?

Home address   
Study address  

Additional remarks

Notes

*I confirm that the above information is stated to the best of my knowledge, and that I received the instruction/reference sheet attached to this request. I understand that

• any false information or deliberate omissions results in an immediate unsubscription from the waiting list,
• in case I do reject an offer I am required to pay a service fee of € 5.00 to the Studentenwerk Paderborn.