Title* Mr Mrs Ms Miss Dr Professor

First Name* Surname*

Address*

Home phone No.* Work Telephone No.

Mobile / Cell No.

Skype Address

Fax E - Mail* *

Please note that Sabbatical Homes will store your email address for the purpose of communicating with you regarding this enquiry and any other services provided by Sabbatical Homes.

It is now a legal requirement for us to have your permission to communicate by email to you therefore by providing us with your email address and submitting this form you agree to allow Sabbatical Homes to send you emails regarding this enquiry and other services we may be able to offer our clients from time to time. We will not sell or give your email address or any other details to any other commercial or charitable organisation without asking for your permission first.

Best Time to Contact Me Best Method to Contact Me Home Telephone Work Telephone Mobile / Cell Phone E Mail Fax

Occupation or post*

University / College / Company Name*

University / College / Company Address*

Purpose of visit to the UK Work Study Vacation If you are working please indicate where you are working. This will help us find you suitable accomodation

Place of Work in London

London Reference Contact Name

London Reference Contact Address

London Reference Contact Telephone :

London Reference Contact Fax :

London Reference Contact Email :

Accommodation required ( (If you have a specific daily destination, university or institute, children's school etc. please state and
we will try to locate you conveniently to it.)

Location* :

Number of bedrooms * 1 2 3 4 5 6

Type of property House Apartment Either Situation City Centre Suburb Country Anywhere

Maximum Travelling Time to Work Destination 10 Minutes by Public Transport 15 Minutes by Public Transport 20 Minutes by Public Transport 30 Minutes by Public Transport 45 Minutes by Public Transport 60 Minutes by Public Transport

Preferred weekly rental (in pounds sterling)* : Select Rental Rate Up to £350 per week Up to £400 per week Up to £450 per week Up to £500 per week Up to £600 per week Up to £750 per week Up to £1,000 per week Up to £1,500 per week Up to £2,500 per week Up to £5,000 per week

( inclusive of council tax, water rates and TV licence, exclusive of light , heat and telephone )

Are you a smoker* : No Yes Do You Have any Allergies? No Yes

If Yes, please indicate type of allergies

Number of adults* : 0 1 2 3 4 5 6

Are you bringing children ? : No Yes

if yes: how many : 0 1 2 3 4 5 6 what sex, Males : 0 1 2 3 4 5 6 Females : 0 1 2 3 4 5 6 what ages

Are you planning to bring any pets? No Yes Maybe If Yes please state what type of pet

Arrival date* Format : dd/mm/yyyy

Departure date* Format : dd/mm/yyyy

BROADBAND CONNECTION (Where one is not already provided)

Do you require Broadband Internet Access ? Select Yes No

Other specific requirements
(e.g. wheel chair access, street level access, blind, other health or physical condition requiring specific facilities.)

Any other information which you feel will help us find you the perfect property :

Character reference ( Cannot be a family member )

Name and address of referee

Name of Referee (Senior colleague, Pastor, Attorney, UK resident)*

Address

Telephone*. Fax* :

e-mail* :

How did you find Sabbatical Homes? Web Search Engine New York Review of Books Advert Recommendation from colleague Recommendation from College Other

if other :