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2023 General English Course Application Form Version 18

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maynard pascual
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14 views3 pages

2023 General English Course Application Form Version 18

Uploaded by

maynard pascual
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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2023 General English Course Application Form

(Version 18, 16 June 2023)

Unique Student Identifier: _______________________________

PERSONAL DETAILS IDENTIFICATION AND VISA STATUS


First name Passport or Driver’s license number
Last name
Date of birth (dd/mm/yyyy)
Gender ☐M ☐F
Are you an Australian permanent resident or
Residential address
Australian citizen?
☐ Yes please attach a copy of evidence
☐ No please specify below:
☐ Student ☐ Temporary resident
Visa type
(please ☐ Visitor ☐ Bridging
attach a ☐ I’m an Australian citizen
copy) ☐ Other please specify:
Post code:
Postal address (if different from above) If you are on student visa, which institution issued
CoE to you?:

Are you currently within the first 6 months of


enrolment at this institution?
Post code: ☐ Yes ☐ No
Contact No.
Email Do you need a Confirmation of Enrolment
(CoE) from BIC?
Do you consider that you have a disability,
impairment or long-term condition?
☐ Yes ☐ No
☐ No ☐ Yes please indicate below:

☐ Hearing ☐ Vision ☐ Physical ☐ Learning


☐ Mental ☐ Other please specify:

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60/188 Newcastle Street, Perth, WA 6000
[email protected]
RTO code: 41560
CRICOS Provider code: 03522E
ENGLISH LANGUAGE PROFICIENCY
IELTS score (attach a copy of certificate if applicable)
Other English language proficiency evidence (attach a copy
of certificate if applicable)

COURSE (starts from Monday)

☐ January Intake ☐ February Intake ☐ March Intake ☐ April Intake


☐ May Intake ☐ June Intake ☐ July Intake ☐ August Intake
☐ September Intake ☐ October Intake ☐ November Intake ☐ December Intake
☐ Week 1 ☐ Week 2 ☐ Week 3 ☐ Week 4
☐ Week 5 Course duration: weeks

How did you hear about BIC?

☐ Social media (e.g. wechat, etc.) ☐ Newspaper ☐ Agent ☐ Friends


☐ BIC website ☐ Google ☐ Flyers or brochures
☐ Other please specify:

AGENT USE ONLY


Agent
Contact person
Contact (phone or email)

Agent Stamp

Authorisation
I hereby authorise the agent specified on this form to apply for course(s) at Babel International College (WA) on my behalf.

Student name:
Student signature:
Date:

2/3
60/188 Newcastle Street, Perth, WA 6000
[email protected]
RTO code: 41560
CRICOS Provider code: 03522E
DECLARATION AND SIGNATURE

⚫ I have read and understood, and agree to be bound by the terms and conditions, policies and
procedures explained in the Student Handbook which is available on www.bic.wa.edu.au and in BIC’s
office.

⚫ I understand that Babel International College (WA) reserves the right to change or reverse any decision
regarding admission or enrolment made on the basis of incorrect or incomplete information.

⚫ I understand that the information collected on this form is to enable Babel International College (WA) to
assess my application, create a record on its student database, undertake statistical analysis, meet
statutory reporting requirements and further inform me about the course to which I am applying as well
as BIC’s other courses/events.

⚫ BIC staff will access the information provided by the applicant for these purposes and disclose to
relevant Australian government agencies where required by laws and regulations, and to contractors
engaged by BIC to perform services on its behalf. Where personal information is to be provided to
contractors, BIC will require to enter into a confidentiality agreement.

⚫ I accept that information supplied in this application may also be made available to a BIC staff to
provide assistance with my application and BIC’s preferred Overseas Student Health Cover provider to
assist with effecting health insurance.

⚫ I understand that the information provided in this form will be used for the purposes of and in relation to
my enrolment at BIC. Where the privacy principles apply, BIC restricts access to staff members who
may need the information in carrying out their responsibilities in the academic and/or personal interests
of the student. BIC does not provide, by commercial arrangement or otherwise the personal information
of students except in the following cases:
a) when authorised in writing by the student to do so.
b) where required or authorised by law to government and regulatory authorities;
c) credit reporting and fraud-checking agencies;
d) or to your authorised representative (e.g. legal representative).

Print name:

Date:

Signature:

3/3
60/188 Newcastle Street, Perth, WA 6000
[email protected]
RTO code: 41560
CRICOS Provider code: 03522E

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