Enrolment Form - City Institute

Level 4, 22 Market Street, Sydney, NSW 2000, Australia
T: +61 2 9279 0041 | F: +61 2 9279 0042
E: info@cityinstitute.com.au | FB: cityinstitute
www.cityinstitute.com.au
RTO ID: 91781 | CRICOS Code: 03256G | ABN: 17 123 969 175
OVERSEAS STUDENTS APPLICATION FORM
APPLICANT DETAILS
Female
Male
Given Names:
Family Name:
D
D
M
M
Y
Y
Date of Birth:
Personal Email:
Phone/Mobile:
Country of Birth:
Nationality:
D
D
M
M
Y
Y
Expiry Date:
Passport No:
Yes
Do you hold a current Australian visa?
If YES what type:
Student
Tourist
No
Working Holiday
Other
D
D
M
M
Y
Y
D
D
M
M
Y
Y
Visa expiry:
Visa Subclass:
Which DIBP office do you wish to apply:
ADDRESS
Address of usual residence (overseas)*
* Student must provide overseas address of usual residence. If the student is currently in Australia an Australian address must also be provided.
Street No:
Unit No:
Street Name:
State:
Suburb:
Mobile:
Telephone:
Postcode:
Country:
Address in Australia:
Street No:
Unit No:
Street Name:
State:
Suburb:
Postcode:
Mobile:
Telephone:
LANGUAGE & CULTURAL DIVERSITY
Is English your first language?
Yes
How well do you speak English:
No
VERY WELL
Do you have any form of formal English testing?
If No, which language do you speak:
WELL
Yes
NOT WELL
NOT AT ALL
No
Overall Score:
Name of test:
Date of test taken:
(Please attach certificate)
Are you of Aboriginal origin?
Yes
No or of Torres Strait Islander origin?
Yes
No
HOW DID YOU HEAR ABOUT US
Agent
Friend
Internet
City Institute Application Form 2015 version June 2015
Relative
Seminar
Other:
Page 1/4
OVERSEAS STUDENTS APPLICATION FORM
www.cityinstitute.com.au
AGENT DETAILS (if applicable)
Agent declaration: I confirm that I have provided current and correct information about City Institute, its policies and procedures, and the terms and
conditions related to this application in accordance with our Agent Agreement with Nortwest Pty Ltd t/a City Institute
Agency:
Tel:
Agency Contact person:
Email:
Signed:
(Print) Name
D
D
M
M
Y
Y
Date:
EDUCATION HISTORY
What is your highest completed school level?
Year 12 or equivalent
(Year completed yyyy)
Year 10/or below (Year completed yyyy)
Year 11 or equivalent
(Year completed yyyy)
Never attended (Year completed yyyy)
Did you complete any tertiary education?
Level of Qualification(s) achieved:
OVERSEAS
Yes
No
Bachelor Degree or higher
Advanced Diploma or associate degree
Diploma
Certificate I - IV
Please list your academic history
Qualification level
IN AUSTRALIA
Institution name and address (country)
Completed
Institution name and address (country)
Completed
Please list your academic history
Qualification level
EMPLOYMENT HISTORY
Which categories best describe your current employment status?
Full time employee
Employed – unpaid worker in a family business
Part time employee
Unemployed – seeking full time work
Self employed – not employing others
Unemployed – seeking full time work
Employer
Not employed – not seeking employment
Which categories best describe your main reason for undertaking this course?
To get a job
It was a requirement of my job
To develop my existing business
I want extra skills for my job
To start my own business
To get into another course of study
To try for a different career
For personal interest or self development
To get a better job or promotion
Other reasons
Please attach a copy of your latest resume listing your work experience, job roles and employers.
Copy of your resume attached:
Yes
City Institute Application Form 2015 version June 2015
No
Page 1/4
OVERSEAS STUDENTS APPLICATION FORM
www.cityinstitute.com.au
RPL & CREDIT TRANSFER / Additional learning needs
Do you wish to apply for RPL?
Yes
No or Credit Transfer
Yes
No
If YES, please visit www.cityinstitute.com.au/RPL for further details about applying for RPL / CT, application form and fees.
DISABILITY
Do you consider yourself to have a disability, impairment or long-term condition?
Yes
Hearing / Deaf
Learning
Vision
Physical
Mental illness
Medical condition
Intellectual
Acquired brain impairment
Other:
Do you have any special learning needs?
Do you require OSHC?
Yes
Yes
No
No
If yes, please select from the list:
If yes, please provide details.
No If YES, what cover do you require:
Single
Family What duration (in months):
If you currently hold OSHC please provide a copy with this application form.
COURSE SELECTION
Preferred session:
AM
PM
D
D
Sydney City
M
M
Y
Brookvale
Y
Preferred course start date:
D
D
M
M
Y
Y
or alternative start date
SVP Application fee $250 (SVP Applicants only)
Enrolment fee $200
BSB30115 Certificate III in Business (22 weeks) (CRICOS 086848G)
ICT20115 Certificate II in Information, Digital Media and Technology (22 weeks) (CRICOS 086485G)
BSB40215 Certificate IV in Business (22 weeks) (CRICOS 086985J)
ICT40315 Certificate IV in Web-based Technologies (48 weeks) (CRICOS 086550C)
BSB51215 Diploma of Marketing (48 weeks) (CRICOS 087425M)
ICT50615 Diploma of Website Development (48 weeks) (CRICOS 086683A)
BSB51415 Diploma of Project Management (48 weeks) (CRICOS 087451J)
Do you plan to continue studying in Australia after completing your studies with City Institute?
Are you applying for ELICOS courses prior to studies at City Institute?
Yes
Yes
No
No
If YES, please specify which institution (Please attach letter of offer to your application):
APPLICATION DOCUMENT’S CHECKLIST
Non SVP applicants
Completed and signed Application Form Highest Qualification Achieved
Copy of Passport English Proficiency
Copy of Visa (if applicable)
Other (Please specify)
SVP applicants
Completed and signed Application Form OSHC for yourself and family (as specified by DIBP)
Color copy of Passport and Visa (certified where required)
Financial viability evidence (where required)
Academic transcripts (translated and certified where required)
Release letter (where applicable)
English Proficiency evidence
Police checks (where requried)
Other (Please specify)
City Institute Application Form 2015 version June 2015
Page 1/4
OVERSEAS STUDENTS APPLICATION FORM
www.cityinstitute.com.au
POLICIES
For information about our Fees and Refund policy, Enrolment policy, Complaints and Appeals policy, Attendance policy, Academic progress policy
and any other policies please refer to http://cityinstitute.com.au/downloads.php
APPLICANT DECLARATION
I declare that the information contained in this application and the supporting documentation is complete and true
I understand that giving of false or incomplete information may lead to refusal of my application or cancellation of enrolment
I am aware of the conditions that relate to my admission and agree to pay all fees for which I am liable
I understand that all fees are quoted in Australian dollars and payments must be made in Australian dollars and paid into the nominated
account
I understand that I am fully responsible for all education and living expenses, both for myself and for all my dependents that accompany
me while I study at City Institute, and am aware that school aged dependents accompanying me will be required to enroll in a private or
government school in Australia and pay all associated fees
I understand that City Institute will inform DIBP about changes to my enrolment and any breach of visa conditions relating to attendance and
satisfactory academic performance
I understand that information provided by me may provide personal details about a student to Commonwealth and State Agencies and the
ESOS Assurance Fund Manager or DIBP if requested
I understand that I cannot change my education provider without written permission from City Institute
I understand that City Institute does not accept students under 18 years
I understand my rights and responsibilities as an international student on a student visa are governed by the Education Services for Overseas
Students (the ESOS) Act 2000 and The National Code 2007, available at www.aei.gov.au
I give my consent (unless otherwise expressed in writing by myself) that my image may be included in City Institute promotional materials
I accept that if an Agent is acting on my behalf, City Institute is authorised to transmit any information in respect of my application for study
and subsequent study details to my agent.
I have read fully and understand and accept the Terms and Conditions of Enrolment detailed on this form.
Student Signature:
D
D
M
M
Y
Y
Date:
PAYMENTS
Payments can be made by:
• Direct deposit
• Electronic transfer
• Cash
• Cheque
• Credit Card (Visa, Master attracts 2%, AMEX attracts 4% surcharge)
Bank Name: ANZ Banking Group
ACCOUNT
DETAILS
Account Name: City Institute
Branch BSB: 012 395
Account Number: 269368895
Swift Number: ANZBAU3M
City Institute Application Form 2015 version June 2015
Page 1/4
RTO ID: 91781 | CRICOS Code: 03256G | ABN: 17 123 969 175
Level 4, 22 Market Street, Sydney, NSW 2000, Australia
T: +61 2 9279 0041 | F: +61 2 9279 0042
E: info@cityinstitute.com.au | FB: cityinstitute
www.cityinstitute.com.au
SVP APPLICANT DECLARATION
You DO NOT need to complete this section if you (the applicant) are not applying to study in an Advanced Diploma with City Institute.
In order to progress your application to the next stage, we require you to complete the following questionnaire, which will enable City Institute to
make an SVP assessment as part of the application process. Applications through agents are to be completed by the applicant’s agent and must be
submitted with the Application.
Information collected on this form and during the enrolment process is required to meet City Institute’s obligations under the Australian immigration
laws. City Institute must ensure student compliance with the conditions of their visas and their obligations under the ESOS Act and the National
Code 2007. The authority to collect this information is contained in the Migration Regulations, the ESOS Act and the National Code 2007. Information
collected from applicants may be requested by the Australian Government, the Tuition Assurance Scheme Secretary and the ESOS Assurance Fund
Manager or any other designated authorities.
STATEMENT OF PURPOSE
The answers provided in this statement will be used by City Institute to undertake a preliminary assessment as to whether you meet the requirements
of a Genuine Temporary Entrant (GTE) and a Genuine Student (GS). However note, that the Department of Immigration and Boarder Protection
(DIBP) will make their own determination of the GTE and GS criteria. Further information on the GTE criteria can be located on the DIBP website:
www.immi.gov.au
• All offshore applicants from AL3 and some AL2 will be contacted by City Institute’s representative for an interview.
• City Institute may also contact applicants currently residing in Australia if deemed necessary.
• You must answer all the questions below as thoroughly as you can.
(Please attach an additional page if you require more space).
1. Why do you want to study in Australia compared to studying in your home country?
2. Why did you choose City Institute compared to other Australian educational providers?
3. How will the program, you are applying to study with City Institute, benefit your current or future career path?
4. Please describe what you intent to do upon completion of studies at City Institute?
City Institute Application Form 2015 version June 2015
Page 1/4
SVP APPLICANT DECLARATION
www.cityinstitute.com.au
5. Explain your current personal circumstances in your home country.
6. Do you wish to bring family dependants (e.g. Wife, children)?
Family / Dependants:
1.
(Please list including
their date of birth)
2.
3.
4.
5.
7. Do you have any close family in Australia (parent, wife/husband, child, brother/sister)? If YES, please provide further information as: What
immigration status they have? How long have they been in Australia?
8. How do you intend to finance your study and living expenses for the entire duration of your stay in Australia?
Private funding
Sponsor
Bank loan
Family
Other
9. Are you relying on working in Australia to cover your tuition and living fees? Yes
No
10. Please indicate the type of accommodation you intend to live in while studying at City Institute?
11. Please list any current or previous immigration history. Have you, or any dependants, been refused visa to Australia or any other country?
Visa type
Granted / Refused
Month and year of grant
12. Have you been reported to DIBP for non-compliance? (This includes being reported for attendance and/or academic progress and/or nonpayment of fees, or being expelled?)
City Institute Application Form 2015 version June 2015
Page 1/4
SVP APPLICANT DECLARATION
www.cityinstitute.com.au
13. Provide the best way for us to contact you to conduct an interview:
Skype
Mobile phone
Viber
WhatsApp
Applicant’s declaration
✓ I declare that the information supplied by me on this form is true and correct.
✓ I declare that my application is genuine and by making this application I have every intention of completing all courses listed in the application.
✓ I declare that all evidence provided with my application is authentic and valid.
✓ I consent to City Institute obtaining information from educational institutions and relevant authorities concerning my entire study history
including enrolment, academic results, attendance and finances.
✓ I understand that information relating to my application may be provided to DIBP.
✓ I have read and understood and accept SVP requirements and above listed conditions.
✓ I have read and understood the Transfer between registered providers policy.
Agent Declaration (if applying through agent)
✓ I undertake to provide support to the student in an honest, ethical and responsible manner, in accordance with the ESOS Act, the National Code
and the Migration Act requirements
✓ I have interviewed the student and believe that s/he is meeting the requirements of Genuine Temporary Entrant and is a Genuine Student as
defined by DIBP and the student intends to comply with visa conditions and complete all the courses enrolled into to the best of their ability.
✓ I have read and understood and accept SVP requirements and above listed conditions.
✓ I have read and understood the Transfer between registered providers’ policy.
Student Signature:
D
D
M
M
Y
Y
Date:
Agent signature:
Agent name
D
D
M
M
Y
Y
Date:
For office use only
APPROVED
PENDING – awaiting the submission of other documentation for final assessment
NOT APPROVED (If not approved, please provide reasons below):
Applicant notified or the outcome
City Institute Application Form 2015 version June 2015
Staff name:
D
D
M
M
Y
Y
Date:
Page 1/4