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Enrolment - International Students
 Personal Details
Title: *
First Name: *
Surname: *
Date of Birth: *
(format dd-mm-ccyy)
Gender: * Male Female

Course Details
USI (If known):
Name of Qualification: *
Mode of Training: *
Type of Training: *
Course Location: *
Intake Date: *
(format dd-mm-ccyy)

 Contact Details
Overseas Address:
Australian Address:
State: Postcode:
Contact Number: *
Mobile: Home:
Email Address: *

 Country of Birth & Nationality
In which country were you born?
What is your nationality (as shown on passport)?
What is your passport number??
Do you currently hold an Australian Visa? *
No
Yes, please specify:
Expiry Date (format dd-mm-ccyy):
 Where will your Student Visa be lodged?:

 Language Proficiency
Have you undertaken a recognised English language test in the last two years? No Yes, please specify: Date: Score:
How well do you read, write and speak English?

 Disability
Do you consider that you have a disability, impairment or long-term condition that might affect your training ? (You may indicate more than one area) No
Yes, please select:
Hearing/deafness
Intellectual
Learning disability
Medical condition
Mental illness
Physical disability
Visual disability
Other, please specify:

Please specify any particular requirements you might have:

 Education Details
Secondary School Studies (please outline your secondary school studies in the table below):
Name of School Name of Qualification Year Completed
Other Studies (please outline any other studies that you have attempted or completed in the table below):
Name of Institution Name of Course or Qualification Year Result Completed
Yes No
Yes No
Yes No

 Career Objectives
Of the following categories which best describes your main reason for undertaking this course? *
Other, please specify:

 Student Declaration
By submitting this form I am agreeing to the Start Education enrolment standard terms and conditions. Prior to enrolment I was informed about training, assessment and support services and about my rights and obligations.I have been provided with further information through Start Education's website www.starteducation.com.au. I understand information provided (including personal details, identification, and training outcomes) may be used by the Department of Education for audit, verification, research, statistical analysis, program evaluation, post-completion surveys and internal management purposes. I declare the information provided in this form is accurate and I consent to the use of my information for these purposes.

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