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International Student Application Form

PERSONAL INFORMATION
Family Name: *
Given Name: *
Gender: *
 
Date of Birth: *
Country of Birth: *
Home Phone Number: *
Mobile Phone Number: *
Fax:
Email: *

ADDRESS
Address in Home Country: *
Address in Australia: *

VISA DETAILS
Passport and Visa Nationality:
DIAC office (Country/City) where application is being lodged:

Passport No.:
Passport Expiry Date.:
Visa No.:
Visa Expiry Date.:
Type of Visa (please tick box applicable)
Student Visitor Bridging

OVERSEAS HEALTH COVER
Do you have Overseas Student Health Cover (OSHC)?
 

If YES, OSHC Provider:
Membership number:
Expiry date:

COURSE PREFERENCES
Name of Course: (List one course you would
like to study at MCIE)

Commencing:

ENGLISH LANGUAGE PROFICIENCY
Do you hold a certificate of English Proficiency (e.g. IELTS)?
 

Overall Band Score:

AGENT DETAILS
Are you using an Agent?
 

If yes, please provide contact details:
Agent’s name:
Address:
Email:
Phone:

EDUCATIONAL QUALIFICATIONS (Documentary evidence of qualifications claimed must be attached. Documents not in English must be accompanied by certified translations)
Highest Qualification Achieved
Qualification:  School/Institution
Country Year Completed
Qualification:  School/Institution
Country Year Completed

Are you applying for a Credit Transfer or Recognition of Prior Learning?
 
(If yes, please submit Recognition of Prior Learning Application and Evidence Form)

APPLICANT CHECKLIST (Before submitting your application to Melbourne City Institute of Education please ensure you have completed all sections of this application form and attached:)
Certified copies of your academic qualification (translated into English):

Evidence of your English language ability:
Copy of passport:
Copy of Visa (if available):

ADDITIONAL NOTES

* I have read and agree to the Enrolment Terms & Conditions