Please tick () the college* that you wish to enrol in:

Academies Australasia Institute (Provider No. 02398A) Clarendon Business College (Provider No. 01953J)

Australian College of Technology

(Provider No. 02408D)

Supreme Business College (Provider No. 02028E)

*Hereinafter, College refers to that college / provider you have ticked above. Terms and conditions referred to overleaf are identical for all these colleges

APPLICATION FOR ENROLMENT - VOCATIONAL COURSES

This form is to be used by all students. Please fill in BLOCK letters. All sections must be completed.

STUDENT DETAILS
Title: First Name (s): Family Name: Date of Birth: Nationality: Visa Type: / / (DD/MM/YYYY) Gender: Passport No: Expiry date (DD/MM/YY): Male Female (Mr / Ms)

OVERSEAS HOME ADDRESS

Address: Suburb/Town/City: Country: International Home Telephone Number: 0011 + country code ( Email: Post code: )

AUSTRALIAN CONTACT DETAILS

Residential Address: Suburb/Town/City: Preferred Contact Number: Australian Home Telephone: Other Telephone: Australian Mobile: Email: State: ( ( 04 ) ) Post code:

SPECIAL NEEDS
Do you have a disability, impairment or long-term medical condition that may affect your studies? If no, please continue to the next question. If yes, please indicate the area/s of impairment. Hearing Other Support requirements (if known): Mobility Vision Learning Medical Yes No

COURSE APPLIED FOR Course Name: Course Duration:

* Mid-term starts may have limited subject choice.

Preferred Start Date* (DD/MM/YYYY):

Jun 12

ACCOMODATION & AIRPORT PICK-UP

Do you require accommodation? If yes, type of accommodation: Homestay Hostel Shared Room Single Room From (D/M/Y): Yes Yes Yes Yes Yes No No No No If yes, please specify: No If yes, please provide your flight details at least 2 weeks prior to arrival. With Meals No Meals To (D/M/Y): Yes No

No. of weeks required (minimum 4 weeks): Do you smoke: Are you allergic to animals? Do you mind living with children? Do you have a special food requirements? Do you require Airport Pick - Up? :

EDUCATION:
Last School/College/University Attended: Highest Qualification Achieved (e.g. High School Certificate, Diploma of xx, Bachelor of xx, etc): Do you wish to apply for Recognition of Prior Learning (i.e. RPL)? Yes No

(If yes, please refer to Recognition of Prior Learning on the Student Information page on the Colleges section of the website (www.aca.nsw.edu.au) for further information.)

English Examination (Please tick the relevant box and indicate your score): IELTS OTHER Score: Score: Date obtained: Date obtained:

Certified copies of relevant academic achievements (including English results) must accompany your application.

Use of Personal Information:

Student information may be shared between the College and relevant regulatory authorities. This information includes personal details, course enrolment details, and the circumstances of any suspected breach of student visa conditions.

Declaration:
I declare that I have read the instructions and that the information submitted on and with this form is complete and accurate in all respects. I acknowledge that the provision of incorrect information may result in the withdrawal by the College of any place which may be offered. I agree to release and indemnify the College and its officers, employees, agents, partners and contractors from and against any liability, claim, action, demand, loss or expense (including legal costs) arising out of or in any way connected with the provision of incorrect information. I acknowledge that I am bound by the statutes and regulations of the College and I agree to pay all fees charged directly to me arising from this enrolment.

Name of Applicant

Signature

Date

FOR APPLICANTS UNDER THE AGE OF 18

Name of Parent/Person with Custody Signature Date

Were you referred to us by an education agent ?

Yes

No

If yes, name/stamp of agent

Office Use Only (tick if confirmed) 1. Copy of passport 2. English Certificate 3. High School Certificate (if applicable) 4. Other Certificates Checked by: Date: / / (DD/MM/YYYY)
Jun 12

Level 6, 505 George Street and Ground Floor & Level 6 and 7 333 Kent Street, Sydney NSW 2000 Ph: +61 2 9224 5500 Fax: +61 2 9224 5560 Email: info@academies.edu.au Website: www.academies.edu.au