Applications

Please fill in the details in this form and click the "submit" button.
The form may also be printed and either faxed or mailed to:

AAEC (Australian American Education Center)
20 Otter Street
Collingwood 3066
Australia
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Telephone: +61 3 9269 1666
Facsimile: +61 3 9269 1669
Email: colinb-osu@nmit.vic.edu.au

AAEC (AUSTRALIA AMERICAN EDUCATION CENTER)
ENROLMENT APPLICATION

General Information
Social Security Number (USA) Medibank number (AUS)
Medibank number expiry date (AUS)
       
If you do not have a Medibank number will you be applying for a Family or Single membership?
       
Title (Mr/Mrs/Miss/Ms) Last (Family) Name
First (Given) Name Other Names
Preferred name    
Birth/Maiden Name (if different from current last name)
Other name(s) by which you have been identified in relevant academic records

Passport Number
 Country of Issue
Country of Birth
 Country of Citizenship
Date of passport expiry
       
Do you hold an Australian or USA Visa?
If YES, type of visa?
If NO, what type of visa will you apply for?
Date of visa expiry
Age
    Date of Birth mm/dd/yyyy
    Gender
Do you have a husband, wife or any dependents?
If YES will they be joining you in your country of study?
Do you have any type of disability? (specify)
Are you applying from inside or outside of Australia or the USA?
Current Address
Number and Street
 City
Apt. or Suite or Unit Number State
    Zip Code
    Country
Home Phone
 Mobile Phone
Fax Number
 Business Phone
e-mail address
    
       
Parents or Overseas Address
Number and Street
 City
Apt. or Suite or Unit Number State
    Zip Code
    Country
Home Phone
 Mobile Phone
Fax Number
 Business Phone
e-mail address
    
       
Correspondence / Emergency Contact Address
Number and Street
 City
Apt. or Suite or Unit Number State
    Zip Code
    Country
Home Phone
 Mobile Phone
Fax Number
 Business Phone
e-mail address
    
Relationship to you?
       
Applicant must be a high school graduate to apply
What was the name of your last school attended
Address and phone number of last school attended
What is the highest level of education passed? (evidence req)
When was your highest level of education passed?
Country of your highest level of education passed?
Date course commenced
Date course finished
Have you studied at another college/university in Australia or in the USA?
If YES year, name of school, name of course, period of study, results (attach)
What are you doing now?
Summary of work experience (evidence req)
What is your first language?
English was the medium language of instruction at school (evidence req)
Have you taken International TOEFL?
If YES result and date required
What language is spoken at home?
Which institution are you applying for?
What course would you like to study?
When would you like to start?
What subject (major) do you plan to study
Approximately how long will you attend your preferred institution?
What are you plans after you finish at this institution?
How will you pay for this tuition?
Would you like to be placed with a host family?

Would you like airport pickup?

 

 

Office Use:
Payment procedure
Fax Authorization
Declaration

Signature
Agent declaration
   
       
       

 

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