Step 1 of 8 12% Your personal detailsWe will contact you be email or telephone. To avoid delays in your application, it is important you complete ALL of your details clearly including your email address. Name (as shown in passport)* First Last Use your legal name as shown on your passport. This name will appear on your academic record as well as your diploma parchment upon graduation. Gender*MaleFemaleIndeterminatePrefer not to discloseDate of Birth*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Will you be the age of 18 when your course commences?*YesNoEmail* Telephone*Residential Address outside Australia (as shown in passport) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country *MUST include postcode Mailing address (if different from above): Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Student NationalityCountry of birth:*Nationality/Citizenship on passport:Passport Number:*Have you visited or studied in Australia previously?YesNoHave you breached any visa conditions?YesNoHave you ever been refused a visa for entry into Australia?YesNoIf Yes, please provide details below.Have you ever been convicted of a crime or offense in any country?YesNo Dependent backgroundWhat is your relationship status?SingleMarried/De FactoSeparated/DivorcedHas she/he previously applied for an Australian visa?YesNoIf you have a partner, is she/he coming to Australia as a dependent on your student visa?YesNoIf yes, provide her/his nameDo you have any children?YesNoIf yes, how many will accompany you to Australia Emergency Contact*Student's immediate family onlyName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Relationship to applicant*PhoneEmail* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Do you have any relatives or friends in Australia? Yes No If yes, please provide details below:Full NameRelationship to youState they live in Course PreferenceUnique Student Identifier Number (please provide if known)From 1st January 2015, all students undertaking a nationally recognised training delivered by a registered training organisation will need to have a USI. The Unique Student Identifier or USI is a reference number made up of 10 numbers and letters. No, I don't have a USI number. I consent Intech Institute on my behalf. No, I don't have a USI number. I will create one myself. If you have not yet obtained a Unique Student Identifier (USI) you can apply for it directly at https://www.usi.gov.au/students/create-your-usiMain reason/s for undertaking this course:* Self development or personal interest To get a better job or better promotion For visa purposes Career progression Further study It was a requirement of my job Additional skills for my job To develop my existing business To start my own business Program choices*Course Code (eg. AUR20516)Course Title (eg. Cert II in Auto Servicing Tech)Proposed Start Date Indicate up to two program choices, in preferential order. If you are not eligible for the first program choice, you will be considered for the second program choice. Where applicable you may be considered for alternate programs other than the two you select. English Language ProficiencyPlease provide proof of competence in English Language. You must attach evidence to show that your English ability meets our requirements, eg. IELTS, TOEFL or PearsonsWhat is the main language spoken in your home?Have you undertaken an IELTS or other approved English language test? Yes No * Please attach a copy of your result. Documents that are not in English must be accompanied by accredited English language translations. I intend to sit for an English proficiency test on:Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920*Enter test datePrevious academic qualificationsQualification NameYear Completed Please list relevant previous, current secondary and post-secondary studies (eg. High school, Tafe, University)Are you currently enrolled or do you hold a current CoE from any other Australian CRICOS registered institution? Yes No If "Yes" please state:Course nameInstitute nameYear enrolled I have successfully completed the following qualifications? (Please tick ALL applicable boxes) Certificate I Certificate II Certificate III Certificate IV (or Advanced Certificate/ Technician) Diploma Advanced Diploma Associate Degree Bachelor Degree Higher Education No, I have not completed any of the above qualifications I haven't completed any of the above in Australia * If you have completed an overseas qualification, please upload a copy of the qualification. I haven't completed any of the above in AustraliaName of institution/SchoolName of course/awardCountry of studyLanguage of instruction (ie. English)Start and End date (ie. month/year)Completed Y/N Details of past education including highest level achieved. Do you wish to apply for credit transfer for previous study? Yes No If Yes, please provide certified copy of subject descriptions you would like considered for credit transfer. Do you wish to apply for Recognition of Prior Learning? Yes No If Yes, please provide a completed RPL application form, available under the RPL page on the website. I am submitting my academic records Drop files here or Documentary evidence of previous and current studies must be attached including full transcripts (statement of results and award certificates) Documents not in English must be accompanied by certified English translations. Supporting DocumentsPlease attach electronic copies of original documents to support your application. I am submitting my passportPlease upload a clear copy of the first and last page of your passportI am submitting my IELTS resultsOther Documents Drop files here or Student DeclarationAll students must read the following information and sign* I declare that the information I have provided on this form is correct and complete. I understand that giving false or incorrect information may lead to the refusal of my application or cancellation of enrolment. I give Intech Institute of Technology permission to obtain official records from an education institution that I do and/or have attended. I understand that if I have applied through an approved Intech Education agent, all correspondence relating to my application will be forwarded to that agent I understand that Intech Institute collects, stores and uses personal information only for the purpose of administering prospective, current and graduate student admissions, enrolment and education and that information collected is confidential and will not be disclosed to third parties without my consent, except to meet government, legal or other regulatory authority requirements. I understand that I must meet all requirements associated with my chosen course, and/or funding arrangement, prior to my enrolment being accepted. I authorise Intech Institute to contact me by email or SMS. I have read the terms and conditions overleaf. I acknowledge and accept the terms and conditions of the college. General privacy statementIntech Institute of Technology Pty Ltd will meet the requirements of the Privacy Act 2001 in relation to the protection of student information. Intech Institute of Technology Pty Ltd is required under the Section 19 of the ESOS Act 2000 to inform DIAC about changes to enrolment details and breaches to visa conditions. Information supplied by the student may be available to Commonwealth and State Govenment Departments or their agencies and the Fund Manager of the ESOS Assurance Fund pursuant to obligations under the ESOS Act 2000 and the National Code 2007. Student NameI hereby accept the form as signed Parent/Guardian Name (If student is Under 18)I hereby accept the form as signedDateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Please provide a detailed answer for each of the following questions. The statement must include: your reasons for choosing Intech Institute and the course of study specified in your application form, your reasons for choosing to study in Australia rather than your home country, the key aspects of this course that interest you, the relevance of the course to your future career/educational plans, particularly in your home country.*If the space is insufficient, attach an additional statement. We encourage you to conduct in-depth research about Intech Institute and your chosen program via our website: www.intech.edu.auCAPTCHA
