Representative/Agent Stamp
Application for admission to an Undergraduate Course
Personal Details
Family Name Given Names Permanent address in home country Title e.g. Mr/Mrs/Dr Male Female
Telephone number in home country Fax number in home country Address (where we can contact you about your application). If applying through an agent, please put the agent’s details here.
Country in which you are submitting this application Telephone Mobile/Cell Phone Fax
Email (Where we can contact you about your application) Date of Birth Citizenship Do you hold a current Australian visa? Day Yes No Month Year Country of Birth If yes, please give category of visa Yes No
Do you have a disability, psychological or medical condition which may affect your studies? If yes, attach supporting documents Will you be bringing family members on a dependant student visa? Yes No
English language proficiency
English is the main language spoken in my home If no, please indicate language I will have / or have taken an on Day IELTS test Month
JCU TOEFL Code is 9811
Yes
No
TOEFL test Year
within the past two years (please tick appropriate box) Please attach original documentation
I have undertaken studies (secondary/high school/university) for a minimum of two years in which the language of instruction was English. Please attach documentary evidence.
preferred COURSE
Name of Course (1st choice) Major e.g. Marketing e.g. Bachelor of Business
Name of Course (2nd choice) Major I wish to study at (tick one only) Townsville Cairns Singapore Brisbane
PLEASE?NOTE: NOT?ALL PROGRAMS ARE?AVAILABLE?AT ALL?CAMPUSES.
When would you like to start your studies: Townsville or Cairns Singapore or Brisbane Teaching Period (semester) Trimester One (February) Two (June) Two (July) Three (October) Year Year
One (February)