APPLICATION FORM
Go online at www.eti.wa.edu.au and complete the online application form for a faster response and live availability of student places or email application and supporting documents to: admissions.eti@dtwd.wa.gov.au
2011 1. Personal Details Name: Family name (as shown on your passport) Given names
Preferred name
Sex (Male/Female)
Date of birth (DD/MM/YY)
Local Address in Australia: Number and street Suburb/Town/Country
Post code
Telephone
(M)
Overseas Contact Details: Number and street Suburb/Town/Country
Post code
Telephone (country code/area code/number) Country of birth
Email address
Nationality (as shown on your passport)
Passport number
Do you have a husband, wife or any dependents who will be joining you in Australia?
Yes
No
Do you have a physical disability or learning difficulty that may require additional programs, equipment or support? (Please refer to page 113 of the course guide for clarification) Yes No If YES, please specify:
2. VISA Are you applying for a visa in Australia or outside Australia? Do you hold an Australian Visa?
Yes
No
In
Outside
Expiry Date
If YES, type of Visa:
Student
Working holiday
Tourist/Visitor
Other – specify visa subclass
If NO, what type of visa will you apply for?
Student
Working holiday
Tourist/Visitor
Other – specify visa subclass
Are you currently enrolled at another College/University in Australia?
Yes
No
Have you been at this institution longer than 6 months?
Yes
No If NO, you must provide a release letter.
Have you been offered a University package?
Yes
No
3. Health Cover You must attach Do you have current Overseas Student Health Cover? evidence of current If YES, who is your provider? health cover.
Yes
No
Membership number:
4. Course Choice
Expiry Date
If NO, do you need Family or Single membership?
Single
Family
English Course: Course name
Campus
Number of weeks
TAFE Course:
Commencement Date (refer to dates page 9)
Course number
Course name
Campus
Please list highest qualification first. If you would like a specific pathway, please list.
Semester/Intake
February
July
Year
Please fax/post application to:
223 Vincent Street, West Perth 6005 Perth Western Australia Tel: 618 9227 5538 | Fax: 618 9227 5540 Email: info@link2uni.com
www.link2uni.com
Do you wish to package this application with a University degree?
Yes
No
If Yes complete and attach the University application form. Go to www.ETI.wa.edu.au for further information, fees and university application forms. Please note that packaged applications take longer to process.
5. English level Please tick the following and provide evidence with your application
English is my first language. English was the language of instruction during my secondary school or college studies and I gained a satisfactory pass in English. I have undertaken an English Course. Course name: I have undertaken an IELTS test. Band scores: Listening
6. Previous studies
English College:
Date: Reading
Overall Band Score: Writing
I have undertaken a TOEFL test.
Date:
I have undertaken a Pearson Test.
Date:
Level of English Course:
Speaking TOEFL Score: Score:
Evidence of qualifications must be attached. Documents not in English must be accompanied by certified translations. Please indicate highest level of education achieved.
Secondary: Name of Qualification (eg. A levels) Country
School/Institution Period of study
Post Secondary: Name of Qualification (eg. Degree) Country
School/Institution Period of study
If you believe you have relevant work experience, please attach evidence with application (ie.employer reference)
7. Offers Please note that offer letters will be sent to both your agent and to the email address listed under contact details.
8. Agent Details (If Applicable)
Agent name: Agent address: Agent telephone (country code/area code/number): Agent email address (all offers will be emailed):
9. Declaration Note: if you are under 18 this declaration must also be signed by your parent or guardian. 1. I declare the information in this application and supporting documentation is true. 2. I acknowledge that the provision of incorrect information or documentation or the withholding of information or documentation relating to my application may result in cancellation of my enrolment. 3. I confirm that I have read a copy of the current ETI Course Guide and information available at www.eti.wa.edu.au and fully understand the requirements of the course. 4. I have read and understood the code of conduct, conditions of enrolment, fee payment and refund policy in the ETI Course Guide or at www.eti.wa.edu.au. 5. I agree that Education and Training International may disclose information in regard to my enrolment and tuition fee status, visa status, course progress and results to my parent(s), welfare carer and/or agent. 6. I consent that my personal information may be made available to Australian Commonwealth and State agencies including DIAC pursuant to obligations under the ESOS Act and the National Code. 7. I understand that this agreement, and the availability of Education and Training International’s complaint and appeals processes, does not remove my right to take action under Australia’s consumer protection law.
Applicant’s Signature
Date
Parent or Guardian’s Signature (if under 18 years of age)
Date
CONTACT DETAILS Education and Training International: Ground floor, 123 Adelaide Terrace, East Perth Western Australia 6004 Postal address: PO Box 6830, East Perth BC Western Australia 6892 Tel (+61 8) 9218 2100 (press 2) Email: admissions.eti@dtwd.wa.gov.au Web: www.eti.wa.edu.au