Application Form for Primary + Secondary Schools (571

PRIMARY + SECONDARY SCHOOLS
> APPLICATION FORM FOR 571 STUDENT VISA
Student Details:
PRINT NAME AS IT APPEARS IN STUDENTS PASSPORT. Please use BLOCK LETTERS. All fields must be completed.
Title (Miss, Ms, etc): .................................. Date of birth (DD/MM/YY): ................................................. Gender M
F
Family name (as shown on your passport): ..................................................... Given name(s): .....................................................
Preferred name: ............................................................. Email address: .....................................................................................
Home Country
Address:
(this email address can be of parents).
Number + Street: ..........................................................................................................................................................................
Suburb/City: ................................................................. Country: ..................................................... Postcode: ...........................
Telephone (country code/area code/number): ................................................................... Mobile: ..............................................
Local Address
in Western
Australia:
Number + Street: ..........................................................................................................................................................................
if known
Telephone: ................................................................................................... Mobile: ....................................................................
Language:
What is your child’s first language? ............................................ What language is spoken at home? .......................................
Suburb: ........................................................................................................ Postcode: ................................................................
Is your child studying English anywhere before commencing studies at a Public Primary or Secondary School? Yes
No
If yes, where? ............................................................................ For how long? ..........................................................................
Citizenship:
Country of Birth: ............................................................................................................................................................................
Country of citizenship (as shown on passport): .............................................................................................................................
Passport number: ........................................................................... Expiry date: .........................................................................
Do you hold a current Australian Visa? Yes
No
Visa expiry date: .......................................................................................
If Yes, what type of visa do you hold? ...........................................................................................................................................
Department of Training and Workforce Development - Customer Service Centre
Education + Training International
Level 7, 3 Forrest Place, Perth WA 6004
Tel: +61 8 9218 2100
Fax: +61 8 9218 2170
Web: www.eti.wa.edu.au
Email: admissions.eti@dtwd.wa.gov.au
Primary + Secondary Schools Application Form
CRICOS Provider Code: 01723A
Issue Date: January 2015
Version: 2.1
Page 1 of 3
Enrolment:
Please select the level of schooling at which you seek admission for your child. Please note that in Western Australia
children are placed in the Year group appropriate for their age.
To commence Pre-Primary, children must turn 5 years old by June 30 of that year.
Pre-Primary
Primary
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Secondary
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
Commencing: ................................................................................ Ending: ................................................................................
List schools in order of preference: As this program runs on spare capacity it is important you identify at least three schools.
(1) ............................................................................................ (2) .............................................................................................
(3) ............................................................................................ (4) .............................................................................................
Previous
Education:
Please attach transcripts of your child’s most recent schooling results
Highest education: ............................................................ Year: .................................... Country: .............................................
Name of school: ................................................................ Year level studied: ......................... Period of study: .......................
Has your child studied at another school in Australia before coming to Education + Training International (ETI)? Yes
If yes:
No
Year: ..................................................... Name of school: ....................................................................................
Year level studied: ................................ Period of study: .....................................................................................
Disability/Medical:
Does your child have a disability, impairment or long-term medical condition which may affect their studies?
Please indicate the type/s of disability:
Hearing
Vision
Learning
Medical
Mobility
Yes
No
Other
Please give brief details about their condition/disability:
.......................................................................................................................................................................................................
.......................................................................................................................................................................................................
Care/Welfare
Arrangements:
Students enrolling into a Public Primary School must be accompanied to Perth with a parent for the duration of their studies.
Primary School
Welfare
Arrangements:
My Child will be residing in Western Australia for the duration of his/her student visa with:
Students enrolling into a Public Secondary School can nominate a blood relative over the age of 21 to be their Guardian (this can be
parents, grandparents, aunt, uncle, brother or sister), please be advised if choosing this option ETI will not be issuing a welfare letter
for visa purposes, the family are to contact Immigration direct. Alternatively ETI can arrange a local carer and homestay family on your
behalf, ETI will then issue the welfare letter for the student. Please complete the below School Welfare Arrangements.
Mothers name: ...................................................................................... Signature: .......................................................................
or Fathers name: .................................................................................. Signature: .......................................................................
I understand that I cannot under any circumstances leave my child in the care of any other persons. Failure to abide by the local carer
agreement set by ETI will result in your enrolment being cancelled. You will be sent a welfare form to be completed with the offer
letter if your child is successful in obtaining a place.
Department of Training and Workforce Development - Customer Service Centre
Education + Training International
Level 7, 3 Forrest Place, Perth WA 6004
Tel: +61 8 9218 2100
Fax: +61 8 9218 2170
Web: www.eti.wa.edu.au
Email: admissions.eti@dtwd.wa.gov.au
Primary + Secondary Schools Application Form
CRICOS Provider Code: 01723A
Issue Date: January 2015
Version: 2.1
Page 2 of 3
Secondary
School Welfare
Arrangements:
We have nominated a local carer/guardian for our child.
Yes
We require ETI to nominate a local carer/guardian for our child.
No
Yes
(Complete below details)
No
(Students will then be placed in Homestay with the local carer/guardian for the duration of their stay - more information will
follow on the family details once the enrolment has been confirmed).
Complete if parents have nominated a local carer/guardian:
(Please note: ETI will not be issuing a welfare letter if this option is picked. Contact Immigration Direct)
Name of local carer/guardian: ......................................................................................................................................................
Relationship to student (must be a blood relative): .....................................................................................................................
Address in Perth: .........................................................................................................................................................................
Telephone: ......................................................................................... Email: ..............................................................................
Do you require airport pickup from Perth International Airport? Yes
Agent Declaration
and Details:
No
(There is an additional cost of $115.00 per person)
I ............................................................................................ of...................................................................................................
confirm that I have counselled and briefed the student and parents about ETI policies and procedures and the terms and
conditions related to this application in accordance with our agent agreement with ETI.
Agent name..................................................................................................................................................................................
Agent telephone: ................................................................... Agent email: ..............................................................................
Declaration:
Information provided by the applicant may be made available to State and Commonwealth agencies and parents.
We certify that the information on this form and supporting documentation is complete and correct. We acknowledge that
the provision of incorrect information or documentation or the withholding of information or documentation relating to my
application may result in the cancellation of my enrolment.
By signing this application form we agree to the following:
> Ensure that my child remains in the care of the nominated local carer/guardian as agreed by Education +
Training International
> Be responsible for any return airfares, living expenses and any additional costs associated with my child attending
a Public School.
> Attend school in accordance with the Australian Government student visa policy.
>Abide by the policies of the Department of Education and Education + Training International and the school at
which the student will be enrolled.
> I understand that placement in a school is based on spare capacity, a suitable education program and at the
Principal’s discretion.
> I will pay all tuition fees associated with this enrolment in the specified time frame.
> I will pay contributions, charges and fees, as determined by the school, directly to the school.
> I understand that personal items such as school and sports uniforms, items for individual student use,
stationery, travel to and from school, excursions/incursions, books, swimming programs and optional courses
of study all incur additional fees.
> I understand placement in an Intensive English Centre is $3,000 per year and English Support classes is
$1,500 per year. This is additional to the tuition fees (2015 prices - subject to review annually).
Applicant’s signature: .......................................................................... Date (DD/MM/YY): ..........................................................
(only if entering secondary schooling).
Parent/Guardian’s name: ...............................................................................................................................................................
Signature: ........................................................................................... Date (DD/MM/YY): ..........................................................
(this form will not be processed unless signed by the parent).
Please note: C
ompletion and lodgment of this form does not necessarily guarantee a place in a Western Australia
Public School.
Department of Training and Workforce Development - Customer Service Centre
Education + Training International
Level 7, 3 Forrest Place, Perth WA 6004
Tel: +61 8 9218 2100
Fax: +61 8 9218 2170
Web: www.eti.wa.edu.au
Email: admissions.eti@dtwd.wa.gov.au
Primary + Secondary Schools Application Form
CRICOS Provider Code: 01723A
Issue Date: January 2015
Version: 2.1
Page 3 of 3