Name
(as shown on your passport)

Family Name

Given Name:

Preferred Title

Mr  Mrs  Ms  Miss  Dr  Other
 

Other names you
are known by

(English name)
 

Your name in
ethnic script

Gender

Male   Female

Date of Birth

 Day /Month/ Year
 

Place/Country of Birth

Place

Country

Passport Details

Passport No.
 

Country

Passport Expiry Date

 Day /Month/ Year
 

Your Citizenship

Other Citizenship currently held

Marital Status

Married
Never Married
De-facto partnership
Engaged
Widowed
Divorced

Children
 

Yes  No

Have you been:

Convicted  Yes  No
Charged     Yes  No
Under investigation Yes  No

for any offence(s) against the law in any country; or

Deported  Yes No
Excluded (refused entry)  Yes No
Removed Yes No

from any country.
 

If you have marked
Yes to any of the above, please provide details

Health Details

Are you currently receiving or likely to require

Dialysis treatment, or a consultant physician has indicated that such treatment will required in the immediate future   Yes No

Treatment for active Tuberculosis  Yes No

Treatment for mental disorder or intellectual disability that has needed care in a hospital or supervised residence for more than 90 days in the last two years   Yes No

Treatment for physical incapacity that required full-time care  Yes No
 

If you have marked Yes to any of the above, please provide details

Describe any medical condition(s) we should know about

Address Details

Address & Post Code
(Residential address in your home country)

Telephone Number
(Please include area code)

Fax
(Please include area code)

Mobile Phone

Email Address

Family Details

Name of father

Job Position

Telephone No.
(Please include area code)

Fax No.
(Please include area code)

Name of mother:

Job Position

Telephone No.
(Please include area code)

Does your family have any close relatives or friends in Australia?

Previous Education

Name of Secondary School

Attended

From To

Highest Qualification gained

Name of University or Technical College

Attended

From To

Highest Qualification gained

Recent Work Experience (If any)

Job Title (1)

From To

Job Title (2)

From To

English

I have studied English for:

years

I have taken the following English tests:

Australia Study Plan

I plan to be in Australia for:

year(s) or  month(s)

The highest qualification I wish to obtain in Australia is:

I wish to apply for the following course of study:

Select a course here English Language Professional/Vocational Secondary School Polytechnic degree or diploma University degree or diploma University postgraduate programme University MBA

I found out about Studying Australia from:

Please select Education Agent Friend from my country Internet/Website Friend in Australia Newspaper Ad