Course And Date Commencement
    Year : Intake:
    Course Description
    Select course One : Select course Two :
    Campus Details
    Select Campus* :
    Personal Information
    Full Name*:
    Gender*: Preferred Name: Date of Birth*: Email*:
    Birthplace*: Country of Birth*: Nationality*: Passport No*:
    Passport Expiry Date*: Visa Number: Visa Expiry Date:
    At which office are you going to apply your visa: Are you of Aboriginal or Torres Strait Islander origin?

    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 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.

    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) :
    Are you still attending secondary school?: Which year did you complete that secondary school level?:
    Have you SUCCESSFULLY completed any of the following qualifications?:
    If yes please select which qualifications form the below list:
    Current English Level
    Is English your First Language? : Please Provide evidence of your English language proficiency. 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?
    2. If yes, then please indicate the area of disability, impairment or long term condition: (you may indicate more than one area):

    3. Do you require special assistance?

    Check List all Attachments
    1. Completed all sections of this application form?
    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