Curtin College International Application Form

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Application Form
Applications received without transcripts and/or students’ personal details cannot be processed. All sections must be completed. Please print in BLOCK LETTERS.
Have you applied for Australian permanent residency status? Yes No If yes, date of application Note: If you obtain Australian permanent residency at any stage during the application process, you will need to advise Curtin College immediately.

PERSONAL DETAILS
Title Given Names Note: On all official documentation your name will appear as Given Name/s, Family Name – if this is not how your name appears in your passport or birth certificate, please print your name as it appears on these documents. Previous Student ID (If previously issued another offer or a previous Curtin College or Curtin University student) Family Name

If your name has changed since you were last enrolled please print previous name. Email DD Date of Birth Passport Number Expiry Date Male Female MM YY Telephone +

PERMANENT ADDRESS (RESIDENTIAl ADDRESS IN HOME COUNTRY)
Number and street Suburb/Town/City Country State Post/Zip code

MAILING ADDRESS (IF DIFFERENT FROM PERMANENT ADDRESS)
Number and street Suburb/Town/City Country State Post/Zip code

MEDICAL / DISABILITY NEEDS
The information below is used to assist Curtin College in monitoring, supporting and improving services to students with medical / disability requirements. Disclosing this information will not necessarily affect your admission to the University. Do you have a disability, impairment or long-term medical condition which may affect your study? Hearing Vision learning Medical Mobility Other: Yes No Yes No

If you have a disability, would you like to receive information on what the College can provide to support you?

PERSONAL STATISTICAL DETAILS
Have you previously visited Australia? In which country were you born? What is the main language spoken at your permanent home residence? Yes No What is your country of citizenship?

EMERGENCY CONTACT DETAILS (HOME COUNTRY)
Full Name Relationship Telephone +

SPONSOR DETAILS (PlEASE ATTACH SPONSORSHIP lETTER IF AVAIlABlE)
Will your tuition fees be paid by an organisation? If ‘YES’, name of organisation Yes No

Integrated pathway to

COURSE SELECTION AND STREAM OF STUDY
Level Certificate IV in University Foundation Studies* Diploma Program *Please indicate stream, otherwise applications cannot be processed TAP (Tertiary Access Program)

Commerce Arts & Creative Industries* Humanities * Stream (if applicable)

Information Technology* Engineering* Actuarial Science

Built Environment* Health Sciences* Mathematical Sciences & Finance

Intake

20

Year

Feb

June/July

Oct

COURSE AT CURTIN UNIVERSITY
Please specify your chosen Bachelor Degree and stream at Curtin University:

EDUCATIONAL QUALIFICATIONS
Are you currently studying in Australia? Yes No

If ‘Yes’, a certificate of attendance and release letter from your current institution may be required. Highest Academic Qualification Institution Attended Country / State Year Completed Are you seeking credit or advanced standing from previous studies? Yes No Year Enrolled Date Results Expected (if applicable)

ENGLISH LANGUAGE PROFICIENCY
Is English your first language? Yes No

If No, what is your main language spoken at home? As all courses are taught in English, applicants will need to meet Curtin College’s English language requirement. If your education qualifications were not completed wholly or predominantly in English, please indicate what test(s) you have taken and the corresponding grade, or simply indicate the test you intend taking. Note: Certified documentary evidence of results must be provided at time of application. IElTS Other (please specify) TOEFl CUTE GCE ‘O’ lEVEl ElACS/EAlD

DECLARATION
I declare the information I have supplied on this form and in the attached documents is correct and complete. I understand that the provision of false or incomplete information may result in cancellation of any offer of enrolment or actual enrolment. The execution of this application form authorises Curtin College and Curtin University, as part of its assessment processes, to seek further information from Australian Government agencies as necessary; this to include but not be limited to Visa Entitlement Online. I have read and understand to make timely payments of any fees or associated costs for which I am liable. I am aware of the likely costs of my stay in Australia and have the necessary financial capacity to meet such costs for the duration of my course. I also understand that any information I provide to Curtin College may be made available to Commonwealth and State Government agencies and the Fund Manager of the ESOS Assurance Fund, pursuant to obligations under the ESOS Act 2000 and the National Code; and that Curtin College is required under S19 of the ESOS Act 2000, to notify DIAC about certain changes to a student’s enrolment and any breach of student visa conditions relating to attendance or satisfactory academic performance (ESOS Act 2000). Execution of this application form constitutes my acceptance of all the terms and rules regarding my admission and enrolment at Curtin College. I authorize Curtin College to retain my tuition fees in accordance with the refund policy if I elect to cancel my enrolment at any time. The execution of this application form authorizes for the information contained in the form to be provided to either Curtin University or Curtin English language Centre (CElC) should Curtin College deem this necessary. D Signature of Applicant Signature of Parent (If applicant under 18 years of age) Date D – M M – Y Y

Date





LODGING YOUR APPLICATION
Please submit this application form, along with the necessary documentation to: Curtin College At Curtin University GPO Box U1987 Western Australia 6845 AUSTRAlIA Provider Codes: Colleges of Business and Technology (WA) Pty ltd CRICOS Code 02042G Trading as Curtin College NTIS Provider Code 51879 Curtin University CRICOS Code 00301J Tel: +61 8 9266 4888 Fax: +61 8 9266 4889 Email: [email protected] Or the Local Representative:

AGENCY STAMP HERE

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