APPLICATION FORM Australian Students
Please print in BLOCK LETTERS
Post-secondary/tertiary education: highest level achieved AƩach cerƟĮed copies of all academic transcripts or mark sheets.
Personal details Title: Mr Ms Mrs Miss Other Family name:
Completed: Yes No
Preferred name: Date of birth: DAY / MONTH / YEAR
Gender: Male Female
Country of birth:
Passport number:
NaƟonality (on passport): Passport expiry date: Are you a ciƟzen or permanent resident of Australia? Yes No If ‘yes’, please provide evidence of ciƟzenship or residency (e.g. a cerƟĮed copy of your birth cerƟĮcate, passport, ciƟzenship cerƟĮcate or visa). Unless veriĮcaƟon is supplied, internaƟonal fees and condiƟons apply. If ‘no’, please complete the ApplicaƟon form for internaƟonal students or apply online at deakincollege.edu.au/apply. Do you grant Deakin College permission to provide your parent or guardian listed below with any informaƟon pertaining to your applicaƟon to study, Yes No ongoing academic progress, results and aƩendance?
Contact details
Language of instrucƟon: Will you be applying for exempƟons (recogniƟon of prior learning)? Yes No If so, provide copies of relevant academic transcripts and a completed ExempƟon ApplicaƟon form (available at deakincollege.edu.au) Have you previously studied at Deakin College?
Yes No
If ‘yes’, please provide your Deakin College student ID number: Have you applied through VTAC?
Yes No
Do you grant Deakin College permission to obtain informaƟon from VTAC for the purpose of this applicaƟon? Yes No
Employment history If you believe you have employment experience that is relevant to the course you are applying for, please aƩach a resume and references.
Please specify when you prefer to begin your studies: Year: March June October
Address:
Postcode:
Home telephone: Mobile telephone: Email address:
Previous studies Secondary Education – highest level achieved AƩach cerƟĮed copies of all academic transcripts or mark sheets. Name of qualiĮcaƟon (e.g. Year 12): Name of school: Country/State:
Language of instrucƟon:
Year completed:
Deakin College course selection
Applicant’s contact details
Completed: Yes No
Name of school/insƟtuƟon: Country/State:
Given names:
Suburb:
Name of qualiĮcaƟon (e.g. degree, diploma):
Year completed:
Pre-university course CerƟĮcate IV in TerƟary PreparaƟon Program Stream: Business B Business G Engineering G Health Sciences B Health Sciences G InformaƟon Technology B Mass CommunicaƟon B Science G University-level (Diploma) course Diploma of Commerce B Diploma of Commerce S Diploma of CompuƟng B Diploma of Engineering G Diploma of Health Sciences B Diploma of Health Sciences G Diploma of Management B Diploma of Media and CommunicaƟon B Diploma of Science G
Deakin University course selection Deakin University course: Campus: Deakin University ID (if applicable):
B!Melbourne Burwood Campus S!Geelong Waterfront Campus G!Geelong Waurn Ponds Campus
Request for disability support
I understand that if I have applied through an approved Deakin College/ Deakin University agent, all correspondence relaƟng to my applicaƟon will be forwarded to that agent.
Do you have a disability that may aīect your studies? Yes No If ‘yes’ please specify: Hearing Vision Mobility Medical Learning Other (please specify): Please aƩach relevant informaƟon so that Deakin College and Deakin University can arrange assistance if possible.
Sponsored students only
I understand that Deakin College and Deakin University fees may increase. I accept liability for payment of all fees as explained in the Deakin College and Deakin University publicaƟons, and I agree to abide by the Deakin College and Deakin University Refund policy (deakincollege.edu.au). I understand that by signing this ApplicaƟon form, I will be sent leƩers of oīer for a program at Deakin College and, if indicated, Deakin University.
Name of sponsoring organisaƟon:
I understand that any condiƟons concerning an oīer of admission will be contained in my leƩer of oīer from Deakin College, which I will be required to read and sign.
Type of sponsorship (e.g. tuiƟon fees, living expenses):
Other information
Applicant’s signature:
How did you Įrst learn about Deakin College? You may Ɵck more than one. ExhibiƟon/seminar Newspaper/magazine Recommended by a friend/relaƟve — if so, is your friend/relaƟve a Deakin College student? Yes No Recommended by an educaƟon agent Internet, please specify: Social media, please specify: Other (please specify):
Date: DAY / MONTH / YEAR
If you are under 18 years of age, your parent or guardian must also sign this applicaƟon form.
Parent’s/guardian’s signature:
Application checklist
I have completed all secƟons of the ApplicaƟon form. I have read and understood the CondiƟons of Enrolment (Deakin College’s full Refund policy is available at deakincollege.edu.au).
Check that you have aƩached: cerƟĮed copies of your academic qualiĮcaƟons*
Date: DAY / MONTH / YEAR Parent’s/guardian’s contact details Family name: Given names:
a cerƟĮed copy of your passport, visa or birth cerƟĮcate
RelaƟonship to applicant:
a cerƟĮed copy of your ciƟzenship documents
Address:
your Tax File Number evidence of your English language proĮciency (if required) Suburb:
Postcode:
Home telephone: Mobile telephone: Email address:
Application submission
Declaration
This applicaƟon form has been submiƩed in:
I declare the informaƟon I have supplied on this form is, to the best of my understanding and belief, complete and correct. I understand that giving false or incomplete informaƟon may lead to my applicaƟon being refused or my enrolment cancelled.
City:
I have read and understood the relevant course informaƟon in the Deakin College and Deakin University brochure and/or on the Deakin College and Deakin University website and I have suĸcient informaƟon about Deakin College and Deakin University to enrol. I understand that the pathway may lead to future studies at Deakin University, subject to Deakin University’s entry requirements. I give permission to Deakin College and Deakin University to verify oĸcial records from an educaƟonal insƟtuƟon aƩended by me, and to supply my contact details and any relevant oĸcial records to educaƟonal insƟtuƟons to which I am eligible for admission. I authorise Deakin College to provide my personal informaƟon, including my contact details and enrolment details, to third parƟes in accordance with Deakin College’s Privacy Policy. These third parƟes include Deakin College representaƟves (agents) acƟng on my behalf; Deakin University (to facilitate progression from Deakin College to the next stage of my studies); and Navitas Limited and its aĸliates (to communicate regarding pathways and services oīered by Navitas Limited and its related companies). For further informaƟon, see Deakin College’s Privacy Policy at deakincollege.edu.au and Deakin University’s Privacy Statement at deakin.edu.au/disclaimer.
Country:
Address for applications Admissions Manager Deakin College 221 Burwood Highway Burwood Victoria 3125 Australia T +61 3 9244 5197 E
[email protected]
F +61 3 9244 5198 W deakincollege.edu.au
Or through a Deakin College representative: Representative’s stamp
CRICOS provider codes: Deakin College 01590J; Deakin University 00113B Melbourne InsƟtute of Business and Technology Pty Ltd trading as Deakin College.
DC150806-1503 0815_AW
any relevant employment documentaƟon (if required) * A cerƟĮed copy is signed by an authorised oĸcer to acknowledge that it matches the original document exactly. Authorised oĸcers include: • Deakin College staī • an authorised Deakin College representaƟve • staī of the insƟtuƟon that issued the document • a JusƟce of the Peace or Public Notary • staī of an Australian Embassy, Consulate or High Commission
