* 1. Title (Mr, Ms, Mrs, etc)

* 2. First Name

* 3. Surname

* 4. During term time In 2012/13 will you live in...

* 5. Mobile Number

* 6. Email Address

* 7. What Campus do you study on?

* 8. What is your year of study for the academic year 2012/13?

* 9. Tell us what interests you about this role

* 10. Please tell us what you would like to achieve from this role

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