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Course And Date Commencement

Year :

Intake:

Course Description

Select course One :

Select course Two :

Personal Information

Full Name*:

Gender*: MaleFemaleOther/Not specified	Preferred Name:	Date of Birth*:	Email*:
Birthplace*:	Country of Birth*:	Nationality*:	Passport No*:
Passport Expiry Date*:	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 Identifier

Compulsory 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?:

What is USI? | Steps to Create your own USI

Address in Australia

Street:	City/Town/Suburb:	State :
Postcode :	Email:	Country:
Home Phone:	Work Phone:	Mobile Phone:

Address in Home Country

Street*:	City/Town/Suburb*:	State :
Postcode* :	Email*:	Country*:
Home Phone:	Work Phone:	Mobile Phone*:

Emergency Contact*

Name *:	Relationship* :	Address*:
Telephone*:	Mobile*:	Email*:

Educational Qualifications

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?:
Have you SUCCESSFULLY completed any of the following qualifications?: YesNo
If yes please select which qualifications form the below list:

Current English Level

Is English your First Language? :YesNo

Please Provide evidence of your English language proficiency.IELTSTOEFLPTECAEOther

Score Achieved:

Year Taken:

Listening :

Reading:

Writing:

Speaking:

Disability and Mental Health

In order to provide appropriate support services, we invite you to give us information about any disability or mental health issue you may have.

1. Do you consider yourself to have a disability, impairment or long term condition?YesNo

2. If yes, then please indicate the area of disability, impairment or long term condition: (you may indicate more than one area):

Hearing/deaf Medical conditionLearningIntellectualVisionAcquired brain injuryPhysicalMental Illness

3. Do you require special assistance?YesNo

Check List all Attachments

1. Completed all sections of this application form? YesNo
2. Your certified copy of Passport*:
3. Attached/enclosed certified copied of your visa:	4. Attached/enclosed certified copies of your qualifications*:
5. Attached/enclosed certified copies of English language proficiency:	6. Attached/enclosed any other certified documents requested in this application form:

Agent Details

Consultant:	Agency:
Agency Email Address:

Declaration Contact

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. The personal information I have provided for this application will be protected in accordance with Sunbeam Privacy Policy and Privacy legislation. The information provided will only be used by Sunbeam for assessing your application for a place in the training course for which you have applied. If unsuccessful, the information will be retained in the records of Sunbeam only for its use for a period of 12 months and will not be disclosed except with your permission. You have a right to access and correct any personal information concerning you held by Sunbeam in the student and financial databases. As required by law and our registration standards, personal information may be shared between Sunbeam and the Australian Government and designated authorities and, if relevant, the Tuition Assurance Scheme. By submitting this application, it is understood that you have read this statement and agreed to the use and disclosure of your personal information as outlined above. For full details please see college website and/or Student Handbook. I hereby declare that the information supplied by me is true and correct. I have read, understand and agree to the Terms and Conditions (including Cancellation, Refund and Complaints policies). I agree to pay all fees owing and by the due dates. I understand that on acceptance of enrollment by Sunbeam a Letter of Offer will be provided and when I accept the Letter of Offer, an eCoE will be issued by Sunbeam.

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