Page 1 - SCOTS_Application form v2

SCOTS ENGLISH COLLEGE PTY LTD TRADING AS SCOTS ENGLISH COLLEGE
AB N: 91 605 117 575 - CRICOS Provider Code: 03497A
Email: info@scotsenglish.edu.au - Website: www.scotsenglish.edu.au
Head Office: Suite 1511, Level 15, 87-89 Liverpool Street, Sydney,
NS W 2000, Australia - Phone: +612 9261 8008
Campus: Level 11, 99 York Street, Sydney, NSW 2000, Australia
Phone: +612 9199 8589

APPLICATION FORM

You are: Overseas Student (Offshore) Overseas Student in Australia (Onshore) Resident student All fields denoted by * are compulsory
STUDENT DETAILS GENERAL ENGLISH (GE)
(6 levels, 10 weeks per level)
First name*
Family name* Morning Evening
Country of Birth* Preferred Monday Start Date:
(dd/mm/yyyy)
Nationality/Country of passport*
Date of Birth Gender (M/F) No. of weeks:
Passport No* Expiry Date* ENGLISH FOR ACADEMIC PURPOSES (EAP)
Visa status* Student visa Tourist/Visitor None (4 levels, 12 weeks per level)
Working Holiday Other
Morning Evening
Are you applying for a student visa (and COE) to study at Scots?* Yes No Preferred Monday Start Date:
City where your student visa application is to be lodged: (dd/mm/yyyy)
Current Address *: No. of weeks:
Unit/Street Number: City/Town/Suburb:
IELTS PREPARATION (IELTS)
Street Name: State: (2 levels, 12 weeks per level)
Postcode: Country:
Morning Evening
Email*: Mobile/Tel: Preferred Monday Start Date:
ACADEMIC RECORD (dd/mm/yyyy)
English Level: No. of weeks:
IELTS CAE FCE TOEIC TOEFL
PTE BULATS NIL Other
DECLARATION
Result: When: dd/mm/yyyy
I declare all information I have given on this form is correct
Highest qualification*: and complete. I have read, understand and accept the
State/ Country: Graduation year: Terms and Conditions and the Cancellation and Refund
Policy and agree to be bound by them. I also understand
Do you plan on further study in Australia after Scots English College? money may be withdrawn from my tuition fees to
No Yes (Preferred Course: reimburse agent expenses and authorise deduction of the
Preferred Institution Name: ) appropriate amount from fees paid. I enclose the required
fees and authorise Scots English College to retain my
tuition fees in accordance with the Refund Policy if I elect
ADDITIONAL SERVICES to cancel my enrolment at any time.
Overseas Student Health Cover - BUPA: No Yes This agreement, and the availability of complaints and appeals
(if Yes please complete the following questions): processes, does not remove the right of the student to take
further action under Australia’s consumer protection laws.
OSHC Duration: months OSHC type: Single Couple Family
Scots English College reserves the right to require further
Airport Pick-up: No Yes information from the student pertaining to this application.
Homestay arrangement: No Yes
Special needs: No Yes Signed:…………………………………..Date………………………................
(What extra support do you require please? E.g. Special learning or physical needs, any (NB: Parent / Guardian to sign if student is under 18 years
dietary restrictions or medical allergies) of age at time of application. Please note only students
18 years above can be enrolled at admission date.)
BREAKS Agent name and contact details:
You can request course breaks during General English and between courses
No. Start date (Monday only) Finish date (Friday only) Weeks