International Application for Admission 2015
Please print CLEARLY in black ink using BLOCK LETTERS.
Submit your application form, with attachments by email: int.apps@scu.edu.au
Mail: Southern Cross University, SCU International, PO Box 157, Lismore NSW 2480
Courier: Southern Cross University, SCU International, Military Road, East Lismore NSW 2480 Ph: +61 2 6620 3876
APPLICATION for
Full degree
English Language Program
Study Abroad
Education Business Partner/Education Collaboration
PERSONAL DETAILS
Have you previously enrolled at Southern Cross University?
Yes
No If ‘Yes’ supply student number Preferred names as you would like displayed on your academic transcript.
Family Name/Surname (As this appears in your passport)
Gender (M/F)
Date of Birth First Given Name Title (Mr/Mrs/Miss/Ms)
Citizenship
Country of Birth
Ms
Mis
Mrs
Mr
dd / mm / yy
Passport Number
Visa Type
F
M
Do you hold a current Australian visa?
Yes
No If ‘Yes’ attach a copy of visa and passport.
Have you or any other dependent ever had an application for entry to Australia refused, or had a visa for Australia cancelled?
Yes
No If ‘Yes’, please provide details on additional page. Are you married?
Yes
No If ‘Yes’, when did you marry? Will any dependants travel with you to Australia?
Yes
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No If ‘Yes’, how many? Have you or any dependent ever had a visa application from another country rejected or cancelled?
If ‘Yes’, provide details on additional page.
Yes
No
Correspondence Address
Agent or Partner Institution (if applicable)
Permanent Address (Student’s home address)
Number and street
Number and street
Suburb/Town
Suburb/Town
State, post/zip code & country
State, post/zip code & country
Email
Email
Phone
Phone
Next of Kin
Full Name
Phone (home)
Relationship
Phone (work)
Do you have a disability, impairment or long-term
medical condition that may affect your studies?
PROGRAM OF STUDY
Course Preferences
Phone (mobile)
Yes
No
If ‘Yes’ please
indicate area(s)
of impairment
Medical
Vision
Major
Scholarship details (if applicable) Will you be receiving a scholarship?
Location
Yes
Mobility
Hearing
Learning
Other (please specify)
Duration
Study period/Year
No
Name of scholarship STATEMENT OF PURPOSE
Provide a statement outlining your responses to the following questions on an additional page.
1. Why did you choose to study in Australia rather than your home country?
2. Explain the relevance of your selected course/s of study to your future educational and/or career plans.
3. Explain any gaps in your study or work history.
CRICOS Provider: 01241G
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STUDY ABROAD
(Non award study for one or two sessions)
Unit Preference
Unit Code
Location
Study period/Year
ENGLISH LANGUAGE PROGRAM
Course
Location
Duration
Study period/Year
Do you require Homestay accommodation?
Yes
No Please note A 10-week Homestay placement is recommended for
EAP programs. If ‘Yes’, complete and return the homestay application found at scu.edu.au/international/apply
If ‘No’, I understand that finding alternative accommodation is my responsibility.
ENGLISH LANGUAGE PROFICIENCY
Is English your first language?
Yes
No If ‘No’ what is your first language? Yes
Was English the language of instruction in previous secondary or tertiary studies? No
If ‘Yes’ please indicate the studies that were completed in English and their combined duration and attach your results to this
application form.
Studies Duration Yes
Have you completed a test of English proficiency in the last two years? If ‘Yes’ please indicate date taken and test name.
/
/
Date Taken
(dd/mm/yy) English Test Name Result (if known) No
Test Report Form Number
If you answered ‘No’ to all of the above English language proficiency questions, you must sit an approved English test and advise us
of the results before an Offer of Admission can be made.
ACADEMIC QUALIFICATIONS
Provide details and documentation of all your qualifications and academic transcripts; include secondary and post-secondary.
Name of Qualification
School/Institution
Country
Started
Secondary School
Tertiary or post-secondary
Are you CURRENTLY studying?
Qualification/Award Yes
Completed
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No If ‘Yes’ please provide details. Institution
Country
Date Results (expected)
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All official transcripts must be submitted, including failures (if any).
Have you been excluded or are you liable for exclusion on academic or other grounds, from any tertiary institution or course following
a previous enrolment?
Yes
No If ‘Yes’, provide details on additional page.
Overseas Student Health Cover (OSHC)
What type of OSHC will you be requiring (tick the relevant category)
Single
Couple
Family
If you are providing your own health cover, please give details _____________________________________________________________
You will need to provide proof of health cover at acceptance stage.
Southern Cross University - International Application for Admission 2015
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ADVANCED STANDING
Are you seeking advanced standing for previous study?
Yes
No
If ‘Yes’ complete an Advanced Standing Application Form, with supporting documentation including a certified copy of the
transcript, comprehensive syllabus details for each relevant unit (descriptions, learning hours, assessment methods and explanation
of weighting of each unit). scu.edu.au/advancedstanding
RELEVANT EMPLOYMENT HISTORY
Provide current Curriculum Vitae (CV) and work references. If insufficient space, attach an additional page.
From
To
Full-time/
Part-time
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mm / yy
mm / yy
mm / yy
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Employer
Position
Duties
APPLICATION CHECKLIST
All documents must be originals or certified copies of originals. Translation of documents into English must be
completed by an accredited translation authority.
Completed International Application for Admission form
Evidence of employment history (if required)
Academic transcripts (with grading system)
Other supporting details on additional page
English language test results
Statement of purpose
Advanced Standing form and documentation
Copy of passport
(include photo page and relevant visa page/s)
Where did you first hear about Southern Cross University?
Agent
Educational Partner
Web other than SCU
SCU website
Friend
Alumni Interview
Exhibition
Publication Other DECLARATION, TERMS AND CONDITIONS AND SIGNATURE
The personal information you provide on this form is protected by the Commonwealth Privacy Act 1998 New South Wales Privacy and Personal Information
Protection Act 1998 and the health information is protected by the Health Records and Information Privacy Act 2002. Details regarding the operation of the
Acts are contained in Southern Cross University’s Privacy Management Plan and may be viewed at: scu.edu.au/privacy
I also understand that:
• Southern Cross University communicates with me via electronic means.
ability and financial capacity to undertake and successfully complete my academic plan.
• The information I have provided to the University may be made available to Commonwealth • The University is unable to provide me with financial assistance if I experience financial
difficulties during the course of my studies.
and State agencies pursuant to obligations under the Education Services for Overseas
Students (ESOS) Act 2000 and the National Code of Practice for Registration Authorities • By nominating an agent, as listed in the “contact address for correspondence”, to
and Providers of Education and Training to Overseas Students.
represent me in my application to the University, I agree to the release of all information
relating to my application and subsequent enrolment at the University to my nominated
• The University is requesting this information so we can process your application for
agent, until such time as this nomination is revoked by me in writing.
admission. When storing information electronically, the University may disclose your
information by virtue of its cloud computing arrangements with cloud servers located in • If my application is part of a package arrangement with an SCU Education Partner, I agree
Hong Kong, Singapore and Ireland. The University is reasonably satisfied these countries
to release my application information to process my application for admission.
have similar privacy protection as afforded under Australian law. Other than specified in
•
If
the payment for my course is made by a sponsor (a third party paying my tuition fees
this form, the University will not disclose your information to others unless required by law
or
nominated by me as my sponsor), I agree to the release of all information to my
e.g. emergency or law enforcement purposes.
sponsor regarding my application and subsequent enrolment including my subject results,
• Providing information to us is not required by law, however if you choose not to, we cannot
progress reports, and enrolment details.
process your application for admission.
• Giving false or misleading information is a serious offence under the Criminal Code of the
• You can request access to your information at any time. To access or update your
Commonwealth Government of Australia.
information refer to the University’s Privacy Officer: privacy@scu.edu.au
• If the University provides Confirmation of Enrolment, or enrols a student on the basis
• I declare I am a genuine temporary entrant and genuine student and intend to come to
of incorrect or incomplete information being supplied by the applicant/student, the
Australia with the primary purpose of academic study, and have the language, educational
enrolment will be withdrawn and no refund will be payable.
I have read and understand the description of the ESOS framework made available at: www.aei.gov.au
I declare that the information provided in this application and the documentation supporting it is true and complete.
Applicant’s Signature Date
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Signature of parent/legal custodian
if student is under 18 years of age Date
SUBMIT FORM
Print FORM
Southern Cross University - International Application for Admission 2015
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