Student enrolment form 2

Personal Details
Tell us something about yourself. Please make sure all the information you input is clear an correct. False or incomplete information might cause future issues with your visa.
First Name*
Last Name*
Date of Birth*
Gender
Contact Details
Phone/Mobile Number
Email Address*
Student Number
USI Number (if applicable)
Other
Passport Number*
Passport Expiry Date
Country of passport
Are you applying:
- Within Australia
- Outside Australia
Have you overstayed your visa in the past?
- No
- Yes
You will be required to provide further information on next page
Do you hold a current Australian visa?*
- No
- Yes
Are you applying through an agency?
- No
- Yes
Have you got an Australian address?
- No
- Yes
Which DIBP Office would you like to apply?
Which DIBP Office would you like to apply?
Your current Australian visa
Please tell us what visa you currently hold.
What Australian visa you currently hold?
- Student
- Working holiday
- Tourist
Visa Subclass
Visa expiry date
Overseas Address
Address of usual residence (overseas). You must provide overseas address of usual residence. In case the student is currently in Australia, an Australian address must be provided as well.
Street Address*
City*
State*
Post Code*
Country*
Address in Australia
If you live in Australia, your address while studying has to be provided as well.
Street Address
City
State/Territory
Post Code
Country
Language & Culture
Tell us where are you from and what languages you speak.
Is English your first language?
- No
- Yes
What language/s do you speak?
English Proficiency
How good is your English?
- Advanced
- Intermediate
- Beginner
Have you got any formal English testing?
- No
- Yes
Name of the test
Score of the test
Date of the test
Culture
Are you of Aboriginal origin or Torres Strait Islander?
- None
- Aboriginal
- Torres Strait Islander
Agent's Details
Please provide following information about your agent.
Select your agent
Agent Email
Agency
Contact person
Contact Information
Phone number
Email
Previous Education
Where did you study before? What is your highest level completed?
What is your highest completed school level?*
Date completed*
Tertiary Education
Did you complete any tertiary education (colleges & universities)?
- No
- Yes
Level of qualification/s achieved*
- Bachelor Degree or Higher
- Advanced Diploma or Associate Degree
- Diploma
- Certificate I - IV
Academic History
Overseas academic history
Organisation Level achieved Date finished
Australian academic history
Organisation Level achieved Date finished
Employment
Which categories best describe your current employment status?
- Full time working employee
- Part time working employee
- Self employed – not employing others
- Employer
- Employed – unpaid worker in a family business
- Unemployed – seeking full time work
- Unemployed – seeking part time work
- Not employed – not seeking employment
Occupation
- Manager
- Professionals
- Technicians and Trades Workers
- Community and personal Service Workers
- Clerical and Administrative Workers
- Sales Workers
- Machinery operators and Drivers
- Labourers
Industry of Employment
Which categories best describe your main reason for undertaking this course?
- To get a job
- To develop my existing business
- To start my own business
- To try for a different career
- To get a better job or promotion
- It was a requirement of my job
- I want extra skills for my job
- To get into another course of study
- For personal interest or self development
- Other reasons
Other Reasons
RPL & Credit Transfer
If you wish to apply for RPL or Credit Transfer, please visit our website for more information.
Do you wish to apply for RPL?
- No
- Yes
Do you wish to apply for credit transfer?
- No
- Yes
Disabilities
Do you consider yourself to have a disability, impairment or long-term condition?
- No
- Yes
Please specify
- Hearing / Deaf
- Learning
- Vision
- Physical
- Mental illness
- Medical condition
- Intellectual
- Acquired brain impairment
- Other
Other, please specify:
Do you have any special learning needs?
- No
- Yes
Please specify:
Course Selection
Preferred course session
- AM (Morning)
- PM (Evening)
Preferred campus
- Sydney CBD
- North Manly
- Bondi College
Preferred start date*
Select Your Courses
Course Selection*
Please select any one of the course or combination of courses.
Other Courses
Do you plan to continue studying in Australia after completing your studies with Nortwest?
- No
- Yes
Are you applying for ELICOS courses prior to studies at Nortwest?
- No
- Yes
Which ELICOS courses are you applying to?
Institution Commencement date Course

You will be required to provide us with letter/s of offer from these institutions.
OSHC
OSHC (Overseas Student Health Cover) is one of your's visa requirements. Please specify what cover you require and for how long.
Do you require OSHC?
- Yes
- No
Type of your cover
- Single
- Family
Duration of your cover (in months)
Insurance Number
How did you hear about us?
How did you hear about Nortwest?
- Agent
- Friend
- Internet
- Relative
- Seminar
Other & Comments
Statement of Purpose
Please answer the questions down below. Make sure your answers are complete and honest.
Why do you want to study in Australia compared to studying in your home country?*
Why did you choose Nortwest compared to other Australian educational providers?*
How will the program, you are applying to study with Nortwest, benefit your current or future career path?*
Please describe what you intent to do upon completion of studies at Nortwest?*
Explain your current personal circumstances in your home country.*
Do you wish to bring family dependants (e.g. your spouse, children)?*
- Yes
- No
If yes, Enter the details below:
Relation Date of birth
Do you have any close family in Australia (parent, wife/husband, child, brother/sister)? If YES, please provide further information such as their immigration status? How long have they been in Australia?*
- No
- Yes
Please provide further information such as their immigration status? How long have they been in Australia?
Relation Immigration Status How long in Australia
Do you have any close family in Australia (parent, wife/husband, child, brother/sister)? If YES, please provide further information such as their immigration status? How long have they been in Australia?
How do you intend to finance your study and living expenses for the entire duration of your stay in Australia?*
- Private funding
- Sponsor
- Bank loan
- Family
- Other
Other, specify:
Are you relying on working in Australia to cover your tuition and living fees?*
- No
- Yes
Please indicate the type of accommodation you intend to live in while studying at Nortwest?*
- Private
- Hotel
- Hostel
- Home stay
Please indicate the type of accommodation you intend to live in while studying at Nortwest?
Have you, or any dependants, been refused visa to Australia or any other country?*
- Yes
- No
Please list any current or previous immigration history. Have you, or any dependants, been refused visa to Australia or any other country?
Visa type Granted / Refused Month and year of grant
Have you been reported to DIBP for non-compliance? (This includes being reported for attendance and/or academic progress and/or nonpayment of fees, or being expelled?)*
- No
- Yes
Comments
Provide the best way for us to contact you to conduct an interview:*
Way of contact Contact number, username...

Ex: Way of Contact may be Skype, Mobile phone, Viber, WhatsApp
Policies & Declaration
For information about our Fees and Refund policy, Enrolment policy, Complaints and Appeals policy, Attendance policy, Academic progress policy and any other policies please refer to www.nortwest.edu.au.
Payments
Payments can be made by:
- Direct deposit
- Electronic transfer
- Cash
- Cheque
- Credit Card (Visa, Master attracts 2%, AMEX attracts 4% surcharge)
Account details
- Account Name: City Institute
- Bank: Commonwealth Bank
- BSB Number: 062 005
- Account Number: 1131 0445
Who is filling out the application?*
Applicant's Declaration
- I declare that the information supplied by me on this form is true and correct.
- I declare that my application is genuine and by making this application I have every intention of completing all courses listed in the application.
- I declare that all evidence provided with my application is authentic and valid.
- I consent to City Institute obtaining information from educational institutions and relevant authorities concerning my entire study history including enrolment, academic results, attendance and finances.
- I understand that information relating to my application may be provided to DIBP.
- I have read and understood and accept admission requirements and above listed conditions.
- I have read and understood the Transfer between registered providers policy.
Agent's Declaration
- I undertake to provide support to the student in an honest, ethical and responsible manner, in accordance with the ESOS Act, the National Code and the Migration Act requirements
- I have interviewed the student and believe that s/he is meeting the requirements of Genuine Temporary Entrant and is a Genuine Student as defined by DIBP and the student intends to comply with visa conditions and complete all the courses enrolled into to the best of their ability.
- I have read and understood and accept admission requirements and above listed conditions.
- I have read and understood the Transfer between registered providers’ policy.
Agent's name
Agent's signature
Please put write your signature into this field using mouse or touchpad.
Declaration & Submit
I understand and agree that:*
- I declare that the information contained in this application and the supporting documentation is complete and true
- I understand that giving of false or incomplete information may lead to refusal of my application or cancellation of enrolment
- I am aware of the conditions that relate to my admission and agree to pay all fees for which I am liable
- I understand that all fees are quoted in Australian dollars and payments must be made in Australian dollars and paid into the Nortwest nominated account
- I understand that I am fully responsible for all education and living expenses, both for myself and for all my dependents that accompany me while I study at Nortwest, and am aware that school aged dependents accompanying me will be required to enroll in a private or government school in Australia and pay all associated fees
- Third ChoiceI understand that Nortwest will inform DIBP about changes to my enrolment and any breach of visa conditions relating to attendance and satisfactory academic performance
- I understand that the personal information I provide may be given to Commonwealth and State Agencies and the ESOS Assurance Fund Manager or DIBP if requested
- I understand that I cannot change my education provider without written permission from Nortwest
- I understand that Nortwest does not accept students under 18 years
- I understand my rights and responsibilities as an international student on a student visa are governed by the Education Services for Overseas Students (the ESOS) Act 2000 and The National Code 2007, available at www.aei.gov.au
- I give my consent (unless otherwise expressed in writing by myself) that my image may be included in Nortwest promotional materials
- I have read fully and understand and accept the Terms and Conditions of Enrolment detailed on this form.
Applicant's Signature
Please put write your signature into this field using mouse or touchpad.
Date*
Application Checklist
Application Checklist
- Completed and signed Application Form
- Highest Qualification Achieved
- Copy of Passport (certified where required)
- English Proficiency
- Copy of Visa (if applicable, certified where required)
- Academic transcripts (translated and certified where required)
- OSHC for yourself and family (as specified by DIBP)
- Financial viability evidence (where required)
- Release letter (where applicable)
- Police checks (where required)
Other, please specify:

Organisation	Level achieved	Date finished

Organisation	Level achieved	Date finished

Institution	Commencement date	Course

Relation	Date of birth

Student enrolment form 2

Personal Details

Contact Details

Other

Your current Australian visa

Overseas Address

Address in Australia

Language & Culture

English Proficiency

Culture

Agent's Details

Contact Information

Previous Education

Tertiary Education

Academic History

Employment

RPL & Credit Transfer

Disabilities

Course Selection

Select Your Courses

Other Courses

OSHC

How did you hear about us?

Statement of Purpose

Policies & Declaration

Payments

Applicant's Declaration

Agent's Declaration

Declaration & Submit

Application Checklist