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Course And Date Commencement

Select an Intake

Select a year

Course Description

Select course One

Select course Two

Personal Information

First Name

Middle Name

Surname

GendeMaleFemaleOther

Date of Birth

Birthplace

Country of Birth

Nationality

Passport No

Passport Expiry Date

Visa Status

Select Visa Status

Visa Number

Visa Expiry Date:

At which office are you going to apply your visa:

Are you of Aboriginal or Torres Strait Islander origin? *YesNo

USI: Unique Student IdentifierCompulsory for all students enrolling in accredited courses as at 1 January 2015. If you have not yet obtained a USI you can apply for it directly at http://www.usi.gov.au/create-your-USI/ on computer or mobile device. Please note that if you would like to specify your gender as ‘other’ you will need to contact the USI Office for assistance.

Do you have your USI number available now?:

Address in Australia

Street

City/Town/Suburb

State

Postcode

Country

Home Phone

Work Phone

Mobile Phone

Address in Home Country

Street

City/Town/Suburb

State

Postcode

Country

Work Phone

Home Phone

Mobile Phone

Emergency Contact*

Name

Relationship

Address

Telephone

Mobile

Educational Qualifications

Have you SUCCESSFULLY completed any of the following qualifications? *YesNo

What is your highest COMPLETED secondary school level? (Tick one box only) :Completed year 12Completed year 11Completed year 10Completed year 9 or equivalentCompleted year 8 or below

Are you still attending secondary school?: *YesNo

Which year did you complete that secondary school level?

If yes please select which qualifications form the below list:

Check List all Attachments

Completed all sections of this application form? *YesNo

Your certified copy of Passport

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Attached/enclosed certified copied of your visa

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Attached/enclosed certified copies of your qualifications

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Attached/enclosed certified copies of English language proficiency

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Attached/enclosed any other certified documents requested in this application form

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Agent Details

Consultant

Agency

Agency Email Address

Declaration Contact

Declare *I declare that the information I have provided to the best of my knowledge is true and correct. I acknowledge that providing any false information and/or failing to disclose any information (including any supporting documents) relevant to my application for enrollment and/or failure to complete an application/enrollment form in full may result in the withdrawal of any offer.

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