Title

Family Name

Given Name(s)

Date of Birth

Gender

Nationality

Country of Birth

Passport No

Date of Expire

Do you hold a current Australian visa?

If yes, which visa do you hold?

Date of Expire

Contact number

Email address

Full Name

Relationship

Contact Number

Email address

Unit No

Street No

Street Name

Suburb

State

Postcode

Country

Unit No

Street No

Street Name

Suburb

State

Postcode

Do you already have USI?

If yes, enter your USI

What is your highest completed school level?

Institution

Year completed

Is English your first language?

If No, which language do you speak?

How well do you speak English?

Do you have any form of formal English testing?

If Yes, Name of test

Overall Score

Date of test taken

Do you consider yourself to have a disability, impairment or long–term condition?

If YES, please select from the list

Do you have any special learning needs?

If YES, please explain

Are you applying through an educational agent?

Agency Name

Agent/Representative Name

Address

Phone

Email

Choose a course

Would you wish to pay your full fees in advance?

Would you wish to pay more than 50% of your tuition fees in advance?

Do you have OSHC?

Do you require Security One 2 Oneto arrange OSHC?

If yes, which cover are you applying for?

Do you wish to apply for CT or RPL?