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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
Choose One
Male
Female
Contact Details
Phone/Mobile Number
Email Address
*
Student Number
USI Number (if applicable)
Other
Passport Number
*
Passport Expiry Date
Country of passport
Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
CĂ´te d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
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?
In Australia
Overseas
Which DIBP Office would you like to apply?
Choose One
Amman
Ankara
Apia
Auckland
Bangkok
Beijing
Beirut
Belgrade
Berlin
Brasilia
Buenos Aires
Cairo
Colombo
Dhaka
Dili
Dubai
Guangzhou
Hanoi
Ho Chi Minh City
Hong Kong
Islamabad
Jakarta
Kuala Lumpur
London
Madrid
Manila
Mexico City
Moscow
Nairobi
New Delhi
Noumea
Nuku'alofa
Ottawa
Phnom Penh
Port Louis
Port Moresby
Pretoria
Santiago de Chile
Seoul
Singapore
Suva
Tehran
Tel Aviv
Tokyo
Vienna
Vientiane
Washington
Yangon
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
*
Choose One
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
CĂ´te d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Address in Australia
If you live in Australia, your address while studying has to be provided as well.
Street Address
City
State/Territory
Choose One
Australian Capital Territory
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western australia
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
Select
2be study
360degree
AIC
Alas Abroad
Arrive Australia
Australia Online
Australia Study Educational Services
Australian Centre
Australiante
Bridge Blue
BridgeMarks
CAPEC AUSTRALIA PTY LTD
CESE Australia
CI Australia
Connection Australia
CONNECTION STUDENT LIMITED PTY
Direct Enrolment
Direction Australia
Easy Ozzy
Education Down Under Visa services
Egali
EMSA
Estudien Australia
Go Study
Hello Australia
Hub Edu
Information Planet
Labour Hire Connection
Let's go study
Link House
Link2 world
My career Australia
Open Conexus
Other
Pacific Center
Puravida Study
Right now study
ROSE AUSTRALIA BRAZIL
S&K International Education
Skillspoint Consulting
Stay Global
Student World
Study Choice
Study Gate Australia
Trip Study
Upper International
Veta
West 1 - World Education Student Travel - Sydney
World Study
Yooz
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?
*
Choose One
Never attended
Year 10 or below
Year 11 or equivalent
Year 12 or equivalent
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
Select
Agriculture, Forestry and Fishing
Mining
Manufacturing
Electricity, Gas, Water and Waste Services
Construction
Wholesale Trade
Retail Trade
Accommodation and Feed Services
Transport, Postal and Warehousing
Information Media and telecommunications
Financial and Insurance Services
Rental, Hiring and Real estate Services
Professional, Scientific and Technical Services
Administrative and Support Services
Public Administration and Safety
Education and Training
Health Care and Social Assistance
Arts and Recreation Services
Other Services
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
21/05/2018
16/07/2018
20/08/2018
15/10/2018
19/11/2018
14/01/2019
18/02/2019
15/04/2019
20/05/2019
15/07/2019
19/08/2019
14/10/2019
18/11/2019
13/01/2020
17/02/2020
13/04/2020
18/05/2020
13/07/2020
17/08/2020
12/10/2020
16/11/2020
11/01/2021
15/02/2021
12/04/2021
17/05/2021
12/07/2021
16/08/2021
11/10/2021
15/11/2021
10/01/2022
14/02/2022
11/04/2022
16/05/2022
11/07/2022
15/08/2022
10/10/2022
14/11/2022
09/01/2023
13/02/2023
10/04/2023
15/05/2023
10/07/2023
14/08/2023
09/10/2023
13/11/2023
08/01/2024
12/02/2024
08/04/2024
13/05/2024
08/07/2024
12/08/2024
07/10/2024
11/11/2024
Select Your Courses
Course Selection
*
Select
Advanced Diploma of Leadership and Management
Certificate III in EAL (Further Study)
Certificate III in EAL (Further Study) + Certificate IV in Business
Certificate III in EAL (Further Study) + Certificate IV in Business + Diploma of Business
Certificate III in EAL (Further Study) + Certificate IV in Business + Diploma of Business + Advanced Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Certificate IV in Business + Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Certificate IV in Business + Diploma of Leadership and Management + Advanced Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Certificate IV in Business + Diploma of Project Management
Certificate III in EAL (Further Study) + Certificate IV in Business + Diploma of Project Management + Advanced Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Certificate IV in Spoken and Written English - Further Studies
Certificate III in EAL (Further Study) + Certificate IV in Spoken and Written English - Further Studies + Diploma of Business
Certificate III in EAL (Further Study) + Certificate IV in Spoken and Written English - Further Studies + Diploma of Business + Advanced Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Certificate IV in Spoken and Written English - Further Studies + Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Certificate IV in Spoken and Written English - Further Studies + Diploma of Leadership and Management + Advanced Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Certificate IV in Spoken and Written English - Further Studies + Diploma of Project Management
Certificate III in EAL (Further Study) + Certificate IV in Spoken and Written English - Further Studies + Diploma of Project Management + Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Certificate IV in Web-based Technologies
Certificate III in EAL (Further Study) + Certificate IV in Web-based Technologies + Diploma of Website Development
Certificate III in EAL (Further Study) + Diploma of Leadership and Management
Certificate III in EAL (Further Study) + Diploma of Project Management
Certificate IV in Business
Certificate IV in Business + Diploma of Business
Certificate IV in Business + Diploma of Business + Advanced Diploma of Leadership and Management
Certificate IV in Business + Diploma of Leadership and Management
Certificate IV in Business + Diploma of Leadership and Management + Advanced Diploma of Leadership and Management
Certificate IV in Business + Diploma of Project Management
Certificate IV in Business + Diploma of Project Management + Advanced Diploma of Leadership and Management
Certificate IV in Spoken and Written English - Further Studies
Certificate IV in Spoken and Written English - Further Studies + Certificate IV in Business
Certificate IV in Spoken and Written English - Further Studies + Certificate IV in Business + Diploma of Business
Certificate IV in Spoken and Written English - Further Studies + Certificate IV in Business + Diploma of Leadership and Management
Certificate IV in Spoken and Written English - Further Studies + Certificate IV in Business + Diploma of Project Management
Certificate IV in Spoken and Written English - Further Studies + Certificate IV in Web-based Technologies
Certificate IV in Spoken and Written English - Further Studies + Certificate IV in Web-based Technologies + Diploma of Website Development
Certificate IV in Spoken and Written English - Further Studies + Diploma of Business
Certificate IV in Spoken and Written English - Further Studies + Diploma of Business + Advanced Diploma of Leadership and Management
Certificate IV in Spoken and Written English - Further Studies + Diploma of Business + Diploma of Leadership and Management
Certificate IV in Spoken and Written English - Further Studies + Diploma of Leadership and Management
Certificate IV in Spoken and Written English - Further Studies + Diploma of Leadership and Management + Advanced Diploma of Leadership and Management
Certificate IV in Spoken and Written English - Further Studies + Diploma of Project Management
Certificate IV in Spoken and Written English - Further Studies + Diploma of Project Management + Advanced Diploma of Leadership and Management
Certificate IV in Spoken and Written English - Further Studies + Diploma of Website Development
Certificate IV in Web-based Technologies
Certificate IV in Web-based Technologies + Diploma of Website Development
Certificate IV in Web-based Technologies + Diploma of Website Development + Advanced Diploma of Leadership and Management
Diploma of Business
Diploma of Business + Advanced Diploma of Leadership and Management
Diploma of Business + Diploma of Leadership and Management
Diploma of Business + Diploma of Project Management
Diploma of Leadership and Management
Diploma of Leadership and Management + Advanced Diploma of Leadership and Management
Diploma of Leadership and Management + Diploma of Business
Diploma of Project Management
Diploma of Project Management + Advanced Diploma of Leadership and Management
Diploma of Project Management + Diploma of Business
Diploma of Project Management + Diploma of Leadership and Management
Diploma of Website Development
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
Husband
Wife
Child
Mother
Father
Brother
Sister
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...
E-Mail
Skype
Mobile Phone
Whatsapp
Viber
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?
*
Agent
Student
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:
File Uploads
Copy of your passport, visa, resume, certificates and other.
Drop files here or
Maximum file upload size is 5MB
Copy of your resume attached
Yes
No
OSHC
Material fee
OL Material fee
Enrollment fee
Offer Letter Enrollment fee
Material Fee Period
OL Material Fee Period