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APPLICATION FOR ENROLMENT 2011 – ACADEMIC AND GENERAL ENGLISH COURSES
Please complete all sections, printing clearly in BLOCK LETTERS
Please return this form and any attachments to your selected SCU English Language Centre
Read and understand the conditions, declarations and policies before submitting your application
Students under 18 years of age on a student visa must have an approved guardian/carer in Australia. See the SCU International Office website for more
details
1. PERSONAL DETAILS (use BLOCK LETTERS)
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Family Name
Title: Mr
Mrs
Miss
Ms
Other
First Names
Preferred Name
Date of Birth:
Day
Month
Year
Sex: Male
Passport Number
Type of visa:
Female
Nationality
Tourist
Student
What is your first language?
Other - Give details
My first language is:
Contact Details
PO Box or Street Address
Suburb/Town
State/Province
Postcode
Country
Telephone
Country code
Area code
Number
Mobile number
Facsimile Country code Area code
Number
Email address:
Are you applying to SCU:
as a private student – Direct applicant
through an Agent (If yes, please provide your Agents details in Section 2 below)
Do you require Homestay Accommodation?
Yes
No
* If no, I understand that finding alternate accommodation is my responsibility
* If yes, please complete and return the Application for Homestay Accommodation Lismore/Coffs Harbour see link:
http://www.scu.edu.au/englishlanguage/index.php/dds?cat_id=1092#cat1092 Tweed Gold Coast see link:
* Please note: 10 weeks Homestay Placement is mandatory for EAP programs.
2. DETAILS OF AGENT & STUDENT AUTHORITY (use BLOCK LETTERS)
Do you appoint an Agent on your behalf in relation to this Application?
Agent name
Yes - Please give details below
No - Please proceed to Section 3
Agent Postal Address
Agent email
Agent phone
Agent facsimile
3. COURSE DETAILS (Please indicate your preference below)
Please note: all classes run for 5 week periods. All students will be entry tested to place you in the correct class.
Course Preference
General English
IELTS Preparation
English for Academic Preparation (EAP)
Location
Proposed commencement date:
Course Duration
Proposed completion date:
Have you completed an IELTS, TOEFL, or any other English proficiency test?
Test Name
Yes
No
If yes, please attach certified copies of the test results (see Section 9 below)
Date of Test
Test Result Overall
R
W
CRICOS
Provider
No.
01241G(NSW),
02621K
(WA),
03135E
(QLD).
L
S
Please indicate which English Language Centre you wish to study at:
Lismore
If so, please return to Southern Cross University, PO Box 157, Lismore NSW 2480 Australia
Coffs Harbour
If so, please return to Southern Cross University, Hogbin Drive, Coffs Harbour NSW 2450 Australia
Tweed Gold Coast If so, please return to Southern Cross University, Riverside Campus, Brett St, Tweed Heads, 2485
Have you applied to study at SCU?
Yes
No
Do you already have an offer to study at SCU?
Yes
No
What course do you plan to study at SCU, when you finish English studies?
Undergraduate
Postgraduate
4. COSTS for 2011:
Tuition:
Enrolment Fee:
Medical insurance:
Homestay:
Homestay Placement:
$310 per week for 25 hours - English tuition only; plus
$220 (one off non-refundable fee); plus
$388.80 per year (compulsory requirement for student visa holders); plus
$195 per week for accommodation with 3 meals daily (if homestay required); $220 per week for Tweed Gold Coast; plus
$195 (one off non-refundable placement fee) $220 for Tweed Gold Coast (if homestay required).
Please Note:
Fees quoted are in Australian Dollars (AUD). Fees quoted are for tuition fees only and were correct at time of publication for the 2011 academic year.
Entry into EAP and IELTS Preparation classes will require Upper-Intermediate or Advanced levels of English. If you are enrolling in IELTS Preparation or EAP, please
include your most recent test results, with Section 2. Entry into the EAP programs vary greatly, depending on your level of English.
General English holiday dates:
17 December 2010 – 3 Jan 2011 (Christmas/New Year)
22 April 2011 – 29 April 2011 (Easter)
19 December 2011 - 2 January 2012 (Christmas/New Year)
For more information, please see the following links:
Homestay:
http://www.scu.edu.au/international/elc/index.php/5/
English Studies:
http://www.scu.edu.au/international/elc
http://www.scu.edu.au/international/elc/index.php/10/
Australian Immigration:
http://www.immi.gov.au
Overseas Student Health Cover:
http://www.medibank.com.au
5. REFUNDS (Tuition Fees - Overseas Students)
Refunds are only available in certain circumstances. These are:
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If a student cancels their enrolment 4 weeks or more before the course begins, they will receive a part refund, except for the $220 enrolment fee, the $195
placement fee, and a $100 administration charge and less any applicable agent’s fees.
If a student cancels their enrolment less than 4 weeks before their course begins, they will receive a part refund, except for the $220 enrolment fee, the
$195 placement fee, a $100 administration charge and one week’s tuition fee of $310, and less any applicable agent’s fees.
If a student cancels their enrolment after their course begins, there are no refunds.
If the English Language Centre is unable to deliver a course in which a student has enrolled, they will receive a full refund, less any applicable agent’s
fees.
If there are exceptional circumstances students can apply for special consideration by writing a letter addressed to the Director of Studies explaining their
reasons why they should receive a refund, or part thereof.
Students can apply for a refund by writing a letter addressed to the Director of Studies giving their reasons for a refund. The above information is a summary of
the refund policy. For more information, see www.scu.edu.au/fees
6. DISABILITY DECLARATION
Do you have a disability, special needs or any medical condition which may affect your studies? Yes
No
please specify
7. DECLARATIONS AND SIGNATURE FOR STUDENTS
Important: Please read the following carefully before you sign the declaration
below. Your application cannot be considered unless you sign this declaration.
Privacy statement: This statement is provided because SCU and the Department of
Immigration and Citizenship seek personal information about you in this application
form. The full text of SCU’s privacy statement may be viewed online at
www.scu.edu.aulpolicy/privacy. By signing the declaration below, you consent to the
collection, use, storage and disclosure of your personal information on the terms and
conditions set out in this direct application form and the SCU privacy policy and
management plan as set out in www.scu.edu.au/policy/privacy.
Applicant declaration and agreement:
I declare and acknowledge that:
(i) (a) that all information and documents provided with this application form are
complete and accurate;
(b) it is my responsibility to ensure that I supply complete and accurate information
and documents in connection with this application;
(c) SCU may withdraw any offer or cancel my enrolment if any information or
documents submitted with this application are incorrect or incomplete; and
(d) SCU may withdraw any offer made to me on or before the lapse date, even if I
have already accepted that offer.
Signature of student
x
Date
(ii) Visa Obligations
As the holder of a student visa, I understand and agree to abide by the requirements
of the student visa, including but not limited to the following:
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I agree to advise SCU on arrival of my address and telephone number in
Australia and to immediately advise SCU of any change in these or any other
of my contact details
•
If I am not the holder of a student visa, I understand that it is my responsibility
to ensure that the visa I hold permits me to undertake the program of study in
which I enrol
(iii) While you are enrolled at SCU
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I agree to be bound by all the rules, policies, procedures and regulations of
SCU (as they may be from time to time)
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I understand that I am fully responsible for my education and living expenses
while studying at SCU
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SCU may send information to me electronically.
This agreement does not remove my right to take further action under Australia’s
consumer protection laws.
Signature of student’s parent/guardian if student is under 18 years of age
x
Date
8. FOR AGENTS (if applicable)
I declare that the student understands the terms and conditions of this application including cancellations and refunds policies, agrees to be bound by the
terms and conditions stated on this form and related documents (eg Acceptance of Offer, Homestay Application etc), and agrees to be bound by all the
rules, policies and regulations of SCU.
The agent declares that all the information given in this application is true and correct
Signature of Agent
x
Date
CRICOS
Provider
No.
01241G(NSW),
02621K
(WA),
03135E
(QLD).