Page 131 - Internationsl Guide 2013-14

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INTERNATIONAL Application FORM 
Section A – Personal Details
Family Name
Given Name
Date of Birth (dd/mm/yyyy)
Sex 
 M  
 F
Applicant’s Home Address
Applicant’s Mobile Phone
Applicant’s Home Phone
Applicant’s Email
Passport Number
Citizenship
Country of Birth
Section B – Visa Details
Are you currently studying in Australia? 
 Yes 
 No  If yes, which institute?
Do you hold an Australian visa? 
 Yes 
 No  If yes, which visa type and subclass:
Visa expiry date:
If no, which visa will you apply for? 
 Student 
 Visitor 
 Business 
 Working Holiday 
 Other
Do you intend to bring family members to Australia? 
 Yes 
 No  If yes, how many family members?
Section C – Course Preference
First preference
Course name
Campus
CRICOS code
Second preference Course name
Campus
CRICOS code
Start date
 February  
 July
Year
*Stream options
 AUTOMOTIVE: Mechanical Technology, Panel Beating, Vehicle Painting, Heavy Vehicle, Marine
 ENGINGEERING: Mechanical Trade, Fabrication, Robotics and Mechatronics, Mechanical Design, Electronics
Are you applying for credit transfer or recognition of prior learning (RPL)? 
 Yes 
 No
Section D – English Language
You are required to meet one of the following requirements:
 English test: Academic IELTS, Pearson’s Test of English, TOEFL Test (attach evidence)
OR provide future test date 
 English equivalency: You have studied at secondary or post secondary level with English as level of instruction (attach evidence)
 I have completed a Chisholm English Placement Test OR I will sit a Chisholm English Placement Test
Section E – ELICOS
Please indicate the number of weeks of ELICOS you wish to study?
 5 weeks  
 10 weeks  
 15 weeks  
 20 weeks  
 25 weeks  
 Other
If you intend to study another course after you complete ELICOS, Chisholm will determine the number of weeks
of ELICOS required. The number of weeks required will be determined by your English test score or by your
Chisholm English Placement Test.
Chisholm student ID:
(if you have previously applied for a Chisholm course)
PO Box 684
T
+61 3 9212 5040
Dandenong VIC 3175
W
chisholm.edu.au/international
AGENT STAMP
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chisholm.edu.au/international