MacKillop House Application form

Name *

Name

First Name

Last Name

Preferred name

Date Of Birth

MM

DD

YYYY

Age

Faith Tradition

Mothers Name

First Name

Last Name

Fathers Name

First Name

Last Name

Guardians Name

First Name

Last Name

Other

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email

Mobile Number

Phone Number

Postal Address

if different from above

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact Name

First Name

Last Name

Relationship

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Best contact number

Last school attended

Year you finish school

Certificate Achieved

Degree or certificate you will study

Commencement Date

MM

DD

YYYY

Completion Date

MM

DD

YYYY

Do you have any Disabilities?

Do you have any Medical or health issues?

Dietary Requirements

Gluten free

Nut allergy

Diabetic

Vegetarian

Vegan

Lactose intolerent

other

If other please list details here

Comments

I declare that this information is true and correct

Yes

No

Do you agree to the terms and conditions of MacKillop House

Yes

No

To download the Conditions of Stay at MacKillop House click here

INTERVIEW ARRANGEMENTS

Applicants will be contacted to arrange an interview. Interviews are usually conducted in person at MacKillop House. However, in the case of international or interstate students alternative arrangements may be made in consultation with the Manager.