Page 1 of 4 Version3- Academies Australasia Polytechnic Pty Limited

CRICOS CODE 02439G

INTERNATIONAL STUDENT APPLICATION FORM
NB: All fields marked
*
are mandatory. Details must be entered before an application can be processed
PERSONAL DETAILS
Family Name * _________________________________________________________________
Given Name * _________________________________________________________________
Victorian Student Number (VSN):________________________(if applicable)
Date of Birth * _____/_____/________ (DD/MM/YYYY)
Gender Male Female
FOR INTERNATIONAL STUDENTS ONLY:
Passport Number * _____________________________________
Nationality * _____________________________________
Country of Birth * _____________________________________
Are you currently in Australia? Yes No
What visa type do you have/will apply for? *
Student Visa Tourist
Permanent Resident Other ________________________________
Visa Expiry Date _____/_____/_______ (DD/MM/YYYY)
Visa Number ______________________________________
CONTACT DETAILS
Home Phone Number * ___________________________________
Mobile Phone Number * ___________________________________
Email * ________________________________________________________
Address * ________________________________________________________
_______________________________ Post/Zip Code ____________
Overseas Student Health Cover (OSHC)
Do you require OSHC?
Yes (please select from options below) No (please provide details)
Single Family ___________________________________
ENGLISH PROFICIENCY
IELTS Overall Score ________________________
Other ________________________
LEARNING LIMITATIONS
Visual, Hearing, Speech impairment
Other disabilities ____________________________________________________
EDUCATIONAL QUALIFICATIONS
Highest Education Qualification _____________________________________________________________
Institution ___________________________
Year Awarded ___________________________
Country ___________________________
Are you currently studying? Yes (If yes, please give details below) No
School / Institution ____________________________________________
Commence: _____/_____/_____ Complete: _____/_____/_____
If you are currentl y studyi ng i n Australi a, pl ease attach Current El ectroni c Confi rmati on of Enrolment (eCoE)
Are you requesting a Credit Transfer? Yes No


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CRICOS CODE 02439G
ACCOMMODATION AND AIRPORT PICK UP
I require Home Stay Yes No
I require Airport Pick Up Yes No
AGENT DETAILS
I authorize the agent detailed below to receive information related to my application.




Scholarship/Promotional Code ______________________________________________________________
How did you hear about Academies Australasia Polytechnic?
Agent
Website
AAP Window
Friend
Print advertising
Exhibition
Other
____________________________________________
APPLICATION CHECKLIST
Before submitting your application, please ensure all sections of application form are completed and attach the following:
Certified copies of your academic qualifications
Evidence of your English Language Proficiency
Copy of your passport
Copy of your eCoE
Copy of your valid visa (if applicable)
Copy of your valid OSHC (if applicable)
Credit Transfer Application Form (if applicable)
STUDENT DECLARATION
PRE-ENROLMENT CONDITIONS
1 I have read and understand the course and fee information on the Academies Australasia Polytechnic website,
http://www.polytechnic.academies.edu.au and in the course information brochure.
2 I understand that Australian law requires student visa holders to notify their Education Provider of any change of address details within 7 days.
3 I understand that it is compulsory to be covered by Overseas Student Health Cover while I am on a student visa.
4 I understand that I am not eligible to transfer to another registered provider, without permission from Academies Australasia Polytechnic Pty Ltd until I
have completed 6 months of my principal course of study.
5 I understand that continuation in the course/s is dependant upon satisfactory academic progress and attendance. Failure to meet these conditions will
result in my case being reported by Academies Australasia Polytechnic Pty Limited to DIAC.
6 I acknowledge that information about the ESOS Framework can be found at
http://www.aei.gov.au/Regulatory-Information/Pages/Regulatoryinformation.aspx.
It is important for international students to understand the ESOS Framework. The Education Services for Overseas Student Act (ESOS) and
regulations set out the legal framework governing delivery of education to overseas students studying in Australia on a student visa.
7 I understand that information collected about me may be shared between the registered provider and the Australian Government and designated
authorities and, if relevant, the Tuition Assurance Scheme and the ESOS Assurance Fund Manager. This information includes personal and contact
details, course enrolment details and changes, and the circumstance of any suspected breach by the student of a student visa condition. In other
instances information collected on this form can be disclosed without your consent where authorised or required by law.
8 I acknowledge that Academies Australasia Polytechnic is committed to protecting an individuals right to privacy in accordance with the Privacy Act
2001.
9 I acknowledge that Academies Australasia Polytechnic reserves the right to alter any course, subject, admissions requirement or fee without notice.
10 I understand that the Community Services program requires a Police Clearance and a Working with Children Check. I also understand that this
program includes an unpaid 400 hour work placement mainly with community services and organisations whose staff and clients include those from
diverse language and cultural backgrounds. I understand that I will be dealing with both male and female clients, the elderly, youth, children, those with
disabilities, mental and physical, as well as individuals different sexual affiliations/preferences, the homeless, drug addicts amongst others.
11 I understand that students in the Hospitality Management programs will be required to handle and prepare meat and meat products in practical
lessons. Students may wear gloves when handling meat. One meat cannot be substituted for another meat. Academies Australasia Polytechnic will
use halal meat when possible. Alcohol may also be used in some practical lessons.
12 I understand that for the English courses, I need to have a minimum attendance of 80 percent; otherwise, Academies Australasia Polytechnic may
report me to DEEWR-DIAC for breaching the 80 per cent attendance requirement.
13 I have read, understood and agreed to Academies Australasia Polytechnic Refund Policy found at http://www.polytechnic.academies.edu.au
/Admissions/Refund-Policy.
14 I am aware that Academies Australasia Polytechnic accepts students with a minimum age of 18 years.

I, _____________________________________________________________________________
Hereby declare that the information supplied in this application and the supporting documentation is true and
correct. I have read, understood and agreed to the terms and conditions.
Signature: __________________________ DD / MM / YYYY (Please complete the course selection on Page 3 &4)
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CRICOS CODE 02439G

ELICOS NUMBER OF WEEKS COMMENCEMENT DATE

General English (046514E) ___________________________ _____/_____/___________
IELTS (067634A) ___________________________ _____/_____/___________
Commencement Dates (General English & IELTS):
2012:
Every Monday

2013:
Every Monday, commencing 07/01/2013
EAP 1 (054830D) ___________________________ _____/_____/___________
Commencement Dates

2012: 2/1, 6/2, 12/3, 16/4, 21/5, 25/6, 30/7, 3/9, 8/10, 12/11

2013: 07/01, 11/02, 18/03, 22/04, 27/05, 01/07, 05/08, 09/09, 14/10, 18/11

EAP 2 (054831C) ___________________________ _____/_____/___________
Commencement Dates

2013: 07/01, 11/02, 18/03, 22/04, 27/05, 01/07, 05/08, 09/09, 14/10, 18/11


HIGHER EDUCATION

Commencement of Higher Education (please tick one) MAR J UL NOV

Are you applying for Course Credit? YES NO
(Please complete credit transfer application form)

COMMENCEMENT DATE
Bachelor of Tourism & Hospitality Management _____/_____/___________


VOCATIONAL COURSES
Commencement of Vocational Courses (please tick one) J AN APR J UL SEPT

Are you applying for Course Credit? YES NO
(Please complete credit transfer application form)
COMMENCEMENT DATE
Cert II in Business (074368M) _____/_____/___________
Cert III in Business (074370F) _____/_____/___________
Cert IV in Frontline Management (074371E) _____/_____/___________
Dip. of Management (074372D) _____/_____/___________

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CRICOS CODE 02439G
Adv. Dip. of Management (074367A) _____/_____/___________
Cert III in Accounts Administration (076991E) _____/_____/___________
Cert IV in Accounting (076992D) _____/_____/___________
Dip. of Accounting (076993C) _____/_____/___________
Adv. Dip. of Accounting (076994B) _____/_____/___________
Cert II in Information Technology (076996M) _____/_____/___________
Cert III in Information Technology (076997K) _____/_____/___________
Cert IV in Information Technology (076998J ) _____/_____/___________
Dip. of Information Technology (076999G) _____/_____/___________
Adv. Dip. of Information Technology (077000G) _____/_____/___________


Student Name: ___________________________________
Student Signature: ___________________________________ _____/_____/___________

Student Services Officer Name: ______________________________
Student Services Officer Signature: ______________________________ _____/_____/___________