ENROLMENT FORM - FORM AB Please answer all questions in English AGENT INFORMATION Agent Name STUDENT INFORMATION Name* Date of Birth* Country of Birth*--- Province/State of Birth*--- City/Town of Birth* Gender*MaleFemale Relationship Status*MarriedSeparatedDivorcedNever Married Passport Number* Country of Passport*BangladeshCambodiaChinaColombiaFijiHong KongIndiaIranJapanNepalSamoaTaiwanVietnamOther Country Course I would like to do*I would like to study English YesNo English OnlySchool of BusinessSchool of HospitalitySchool of CookerySchool of Community ServicesSchool of SportsSchool of Information TechnologySchool of MassageSchool of AviationSchool of Building, Construction and EngineeringSchool of TourismSchool of LogisticsSchool of FashionSchool of Hairdressing and BeautySchool of Nursing STUDENT ADDRESS Country*BangladeshCambodiaChinaColombiaFijiHong KongIndiaIranJapanNepalSamoaTaiwanVietnamOther Country Province/State*--- Street Number and Street Name* Suburb* Postcode* PHONE NUMBER Please include country code and area code Home* Mobile* Work* EMERGENCY CONTACT PERSON Name* Relationship* Mobile Number* ENGLISH LEVEL How well do you speak English?VERY WELLWELLNOT WELLNOT AT ALL HEALTH Do you have a disability or long term medical condition?YesNo If yes, what is it? VISA HISTORY Have you travelled to Australia before?YesNo If yes, when and why did you travel? Have you held a visa to another country?YesNo If Yes, Which Ones? Have you studied in another country?YesNo If Yes, Which ones? Do you have any brothers, sisters or parents in Australia?YesNo If Yes, who are they and what is their Visa Status? Have you been refused a Visa to Australia before?YesNo If yes, what type of visa was refused and when was it refused? Have you been refused a Visa to any other country before?YesNo If yes, what type of visa was refused and when was it refused? SCHOOL What is the highest completed school level.*YEAR 12YEAR 11YEAR 10YEAR 9YEAR 8Never Attended School What date did you complete school?* Name of School?* Country*BangladeshCambodiaChinaColombiaFijiHong KongIndiaIranJapanNepalSamoaTaiwanVietnamOther Country State/Province*--- PLEASE LIST ALL QUALIFICATIONS COMPLETED AFTER YOU COMPLETED SCHOOL Name of Qualification Start Date Finish Date Name of College Country --- --- --- --- PLEASE LIST YOUR EMPLOYMENT HISTORY SINCE YOU FINISHED SCHOOL Position Title Start Date Finish Date Monthly Salary Business Name Business Address Business Phone No. Manager Name Manager Contact Number FAMILY DETAILS Please list your Husband / Wife, Sons and Daughters. Relationship Surname First Name Birth Date Town of Birth Province/State of Birth Passport National ID Card HusbandWife YesNo YesNo SonDaughter YesNo YesNo SonDaughter YesNo YesNo SonDaughter YesNo YesNo SonDaughter YesNo YesNo SonDaughter YesNo YesNo Please list all your Brothers and Sisters: Relationship Surname First Name Birth Date Father Mother BrotherSister BrotherSister BrotherSister BrotherSister FINANCIAL INFORMATION Have you saved enough money for your studies in Australia?YesNo Will someone else help you with money if you need it?YesNo If yes, who will help you with money if you need it?MotherFatherHusband/Wife COUNTRIES VISITED Please list ALL COUNTRIES you visited in the last 10 years. Date Arrived Date Departed Country Reason for Visit --- --- --- --- --- --- CHARACTER Have you ever been charged with any offence that is awaiting legal action?YesNo Have you ever been convicted of an offence in any country?YesNo Have you ever been the subject of an arrest warrant or Interpol notice?YesNo Have you ever been found guilty of a sexually based offence involving a child?YesNo Have you ever been named on a sex offender register?YesNo Have you ever been directly or indirectly involved in, or associated with, activities which would represent a risk to national security in Australia or any other country?YesNo Have you ever been associated with a person, group or organisation that has been or is involved in criminal conduct?YesNo Have you ever been associated with an organisation engaged in violence or engaged in acts of violence (including war, insurgency, freedom fighting, terrorism, protest) either overseas or in Australia?YesNo Have you ever served in a military force, police force, state sponsored / private militia or intelligence agency (including secret police)?YesNo Have you ever undergone any military/paramilitary training, been trained in weapons / explosives or in the manufacture of chemical/biological products?YesNo Have you ever been involved in people smuggling?YesNo Have you ever been removed, deported or excluded from any country (including Australia)?YesNo Have you ever overstayed a visa in any country (including Australia)?YesNo Have you ever had any outstanding debts to the Australian Government or any public authority in Australia?YesNo HEALTH Have you ever had, or currently have, Tuberculosis?YesNo Have you been in close contact with someone who has had Tuberculosis?YesNo Have you ever had a chest x-ray that shows something unusual?YesNo Do you suffer, or have you ever suffered, from mental health problems?YesNo Have you ever been told you are HIV positive?YesNo Have you ever had a positive Hepatitis B or Hepatitis C blood test?YesNo Do you have or have you had cancer in the last 5 years?YesNo Do you have high blood sugar / diabetes?YesNo Do you have a blood condition?YesNo Do you have bladder or kidney problems?YesNo Are you, or have you ever been, addicted to drugs or alcohol?YesNo Are you pregnant?YesNo Are you taking any prescribed pills or medication?YesNo Do you have a physical or intellectual disability?YesNo Do you have heart problems, including high blood pressure or a heart condition that you were born with?YesNo Have you ever been admitted to hospital and/or received medical treatment for an extended period for any reason (including for a major operation or treatment of a psychiatric illness)?YesNo AFTER YOU SUBMIT THE FORM ONE OF OUR FRIENDLY CONSULTANTS WILL CONTACT YOU TO COMPLETE ENROLLMENT Alternatively, visit our office and we’ll do everything for you.
