PERSONAL INFORMATION
Student ID (If currently a student of UTAS)
* Title:
Please select ...
Mr
Mrs
Ms
Miss
Dr
* Family Name:
IMPORTANT: must be identical to passport
* Given Name(s):
* Date of Birth:
DD/MM/YYYY (30/01/1982)
* Gender:
Please select ...
Male
Female
* Country of Citizenship:
Please select ...
Albania
Algeria
Andorra
Angola
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire (Ivory
Coast)
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Diego Garcia
Djibouti
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland Island
Guadeloupe
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Japan
Jordan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius Island
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa (U.S.)
Samoa (Western)
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Surinam
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey/Cyprus
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA/Canada
Vanuatu
Venezuela
Vietnam
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
* First Language:
Please select ...
Acholi
African Languages
Afrikaans
Akan
Albanian
American Languages
Amharic
Arabic(including Lebanese)
Armenian
Aromunian (Macedo-Romanian)
Asante
Assyrian(including Aramaic)
Auslan
Australian Indigenous
languages
Basque
Belorussian
Bengali
Bisaya
Bosnian
Bulgarian
Burman (Inc Lisu, Pho,
Rawang)
Burmese
Cantonese
Catalan
Cebuano
Celtic (Breton, Cornish,
Manx)
Chinese (Inc Chang
Chow,hunan, Kan)
Croatian
Czech
Danish
Dravidian (Inc Brahui,
Malto, Tulu)
English
Estonian
Fijian
Finnic (Inc Karelian,
Lapp, Ludic)
Finnish
French
Frisian
Gaelic(Scotland)
German
Gilbertese
Greek
Gujarati
Hakka
Hebrew
Hindi
Hmong
Hmong-Mien (Mien, Yao)
Hokkien
Hungarian
Iberian
Romance (Inc Crioulo, Galician, Ladino)
Icelandic
Ilokano
Indo-Aryan
(Inc Assamese, Kashmiri, Rajasthani
Indonesian
Invented Languages
Iranic (Inc Balochi,
Ossetic, Tajik)
Irish
Italian
Japanese
Kannada
Khmer
Konkani
Korean
Kurdish
Lao
Latin
Latvian
Letzeburgish
Lithuanian
Macedonian
Makaton
Malay
Malayalam
Maltese
Mandarin
Maori (Cook Island)
Maori(New Zealand)
Marathi
Mauritian Creole
Middle Eastern and North
African
Mon-Kmer (Inc Khasi,
Khmu, Muong)
Motu
Nauruan
Nepali
Netherlandic
Niue
Norwegian
Oceanic Austronesian
Oceanic Pidgins and Creoles
Oromo
Other Eastern Asian
Other Eastern European
Other Southeast Asian
Other Southern Asian
Other Southern European
Papuan
Pashto
Persian (Farsi)
Polish
Portuguese
Punjabi
Romanian
Russian
Samoan
Scandinavian (Faeroese)
Serbian
Shona
Sign Languages
Sindhi
Sinhalese
Slovak
Slovene
Somali
Spanish
Swahili
Swedish
Tagalog (Filipino)
Tai (Inc Buyi, Jui, Tho)
Tamil
Telugu
Teochew
Tetum (Timorese)
Thai
Tigrinya
Timorese
Tok Pisin
Tongan
Turkish
Turkish and Central Asian
Ukrainian
Urdu
Vietnamese
Welsh
Western Austronesian
Wu
Yiddish
Yoruba
Zulu
* Country of Birth:
Please select ...
Albania
Algeria
Andorra
Angola
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire (Ivory
Coast)
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Diego Garcia
Djibouti
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland Island
Guadeloupe
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Japan
Jordan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius Island
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa (U.S.)
Samoa (Western)
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Surinam
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey/Cyprus
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA/Canada
Vanuatu
Venezuela
Vietnam
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
* Home Address:
Country:
Please select ...
Albania
Algeria
Andorra
Angola
Argentina
Armenia
Aruba
Ascension Island
Australia
Austria
Azerbaijan
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire (Ivory
Coast)
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Diego Garcia
Djibouti
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland Island
Guadeloupe
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Japan
Jordan
Kenya
Kiribati
Korea (North)
Korea (South)
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius Island
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar (Burma)
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Samoa (U.S.)
Samoa (Western)
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
St. Helena
St. Pierre and Miquelon
Sudan
Surinam
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey/Cyprus
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
USA/Canada
Vanuatu
Venezuela
Vietnam
Yemen
Yugoslavia
Zaire
Zambia
Zimbabwe
Postcode:
* Home Telephone:
Fax:
*Email:
Agent (if applicable):
Sponsor/Scholarship:
Are you applying for a scholarship or receiving sponsorship in your home country?
Enter the name of scholarship/sponsorship:
*IELTS or TOEFL:
Have you taken an English test in the past two years?
Yes
No
*Visa Type:
What type of visa will you apply for?
Student (not applicable for Part Time English)
Visitor (maximum 10 weeks study)
Working Holiday (maximum 10 weeks study)
Dependant (maximum 10 weeks study)
PROPOSED COURSE OF STUDY
*Preferred Course:
General English
Academic English
Direct Entry Academic Program (DEAP) (see entry requirements)
Part Time English (Launceston only/Student Visa holders not eligible)
*Total Number of Weeks:
5 weeks
10 weeks
15 weeks
20 weeks
25 weeks
30 weeks
35 weeks
40 weeks
45 weeks
50 weeks
Enrol in 5 week blocks (eg. 5, 10, 20 etc.)
*Intended Start Date
DD/MM/YYYY (30/01/2009)
*Campus:
Launceston
Hobart (not applicable for Part Time English)
DECLARATION
I declare that the information provided in this application and the documentation supporting it is true and complete. I understand that the University reserves the right to vary or reverse any decision regarding admission or enrollment made on the basis of incorrect or incomplete information. I understand that the information that I have provided to the University may be made available to Commonwealth and State agencies pursuant to obligations under the Education Services for Overseas Students Act 2000 and the National Code of Practice for Registration Authorities and Providers of Education and Training to Overseas Students. I further understand that it may be disclosed to third parties for the purpose of progressing my application. I also understand that the University is required by law to inform the Department of Education, Employment and Workplace Relations of certain changes to my enrolment and of any breach of a student visa condition relating to attendance and satisfactory academic performance.
TO FINALISE YOUR APPLICATION
Have you:
Sent us a copy of your IELTS/TOEFL results, if relevant?
Have you:
Sent us a copy of your passport?
Have you:
Sent us a copy of your Sponsorship letter/Financial Guarantee, if relevant?
By
pressing the submit button on this form you are stating you understand
and agree to the above Declaration.