Application form for the Monash University

Registered agent’s stamp.
Application form for the Monash University English Language Centre
HOW TO COMPLETE THIS FORM
Please write clearly in black ink using capital letters in English.
Include one set of supporting documents with this application including certified English translated copies.
A non-refundable application fee of A$100 must be paid when you submit this form
All supporting documents for this application must be certified as true copies of originals.
Ensure that you sign the declaration at the back of this form.
Please note that delays may occur in the processing of this application if the application is incomplete.
1. Visa-related information
Are you a citizen or permanent resident of Australia, or citizen of New Zealand? ■ Yes ■ No
Do you have a current Australian visa? ■ Yes ■ No
If Yes, Visa type and
expiry date:
For more information visit monashcollege.edu/how-to-apply/student-visas.html
2. Personal details
Given name(s):
Family name:
D
Date of birth:
D
/
M
M
/
Y
Y
Y
Y
Gender: ■ Male ■ Female
Please attach a certified translated copy of your passport.
Permanent address in home
country (required) must
include postcode:
Telephone
(with country code):
Mobile:
Fax:
Email (mandatory):
Address for correspondence
(only if different from your
permanent address in your
home country – not including
agents, address):
Telephone
(with country code):
Mobile:
Fax:
Email (mandatory):
Monash Registered Agents:
If you apply through an agent please ensure that your agent is registered with Monash University or you may experience delays in your application.
For details of registered agents in your country please go to monash.edu/agents.
Country: Agency name: Agent staff name:
Telephone:
Email (for correspondence) :
3. Students with disabilities
Do you have a disability, impairment or long-term medical condition that may affect your studies?
■ Yes
■ No
If yes, Monash will require medical documentation from a relevant treating professional outlining the impact of your condition on your ability to meet the university academic demands.
Disclosure of disability is treated confidentially and will not be used to disadvantage you. The Social Justice Unit at Monash may contact you to discuss the services available.
More information: monash.edu/equity-diversity/disability
4. English Language courses
Please select your preferred Monash University English Language Centre course:
■ Monash English (ME)
Duration:
weeks, (minimum five weeks)
■ Monash English Bridging
Duration:
weeks, (10 or 15 weeks)
■ Introductory Academic Program (IAP), 5 week course
Preferred course start date:
/
M
MYYYY
1
5. English proficiency
Please tick the appropriate box and attach certified copies of all original results.
■ English was the language of instruction in my previous studies (documentary evidence must be provided if institution is located in a non-English speaking country).
■ I have achieved a satisfactory level of performance in English as a subject in an Australian Year 11 or Year 12 equivalent course.
■ I will sit/have sat for an English language proficiency test.
Result (if known) Overall Listening ■ IELTS or
■ TOEFL
Reading ■ Pearsons Test of English (Academic)
Writing/TWE Speaking
Please note, only test results taken two years prior to commencement will be accepted.
■ I have completed the Monash English Placement Test through a registered Monash agent. Test Result (office use only)
Date taken: DD
/ MM
/ YY YY If you do not meet the English language entry requirements for your chosen course, you may receive a Conditional Offer for an English language program.
6. Parent/Guardian details for applicants under 18 years of age
If you are under 18 year of age, by law, you must have acceptable arrangements for your guardianship and accommodation for the duration of your student visa or until you turn 18, whichever occurs first.
Your parents and/or legal custodian can give their permission by completing this section of the Application form.
Name (Parent or Guardian):
Relationship to student:
Signature
Telephone (with country
code):
Email:
Mobile:
7. Declaration
The application form is submitted by: ■ Self (direct applicant)
■ Monash registered agent
■ Other (e.g. sponsor, AusAID).
Name of other:
Agent and agent’s
address
(if applicable):
Code:
Country:
I warrant that the information on this form, or provided in support of my application, is correct and complete. I acknowledge that the provision of incorrect information or the withholding of
relevant information relating to my application, including academic transcript(s), might invalidate my application and that Monash College Pty Ltd or the University may withdraw an offer of
a place or cancel my enrolment in consequence. Should the University determine that I have submitted a false document, I consent to Monash College Pty Ltd or the University disclosing
this information to other relevant tertiary institutions.
I consent to any educational institution at which I have previously been a student and/or my current or any past employer, providing Monash College Pty Ltd or Monash University with
information which that institution or employer holds about me for the purpose of Monash verifying my grades and/or qualifications or experience. I agree to abide by the statutes,
regulations and policies of Monash University.
I have read and understood the above conditions and accept them in full.
Signed as passport (student)
Signed (parent or legal guardian if applicant is under the age of 18)
Return this form and supporting documents to: Central Admissions, Monash University
Monash Connect
Building A, Ground floor
900 Dandenong Road, Caulfield East
VIC 3145, Australia.
Date
DD
/ MM
/ YY YY
Date
DD
/ MM
/ YY YY
OR by email: [email protected]
2
8. Application fee payment
You can pay the A$100 application fee by credit card, money order or bank draft payable to Monash University.
Bank drafts/money orders will need to be mailed or delivered in person to International Recruitment Services. Please ensure you include your full name and date of birth on the back
of the bank draft/money order.
Credit card payments can be made at the following link: www.monash.edu.au/fees/payment/payment-options.html.
If you have made payment using the online credit card service (from the above link), please print a copy of the payment confirmation email and attach to this application form upon
submission.
If your A$100 application fee has been waived by Monash recruitment staff please insert the valid fee waiver promotion code or obtain the recruitment staff signature here:
Staff signature: Waiver promotion code: Collection of personal information
The information collected by us, or on our behalf, during the admissions process and any subsequent candidature as a student at Monash College Pty Ltd (including digital images) is collected for the primary purpose of considering your application
for admission to Monash College courses and, if you are successful, administering your course. For information relating to other purposes of collection and the type of organisations your personal information may be disclosed refer to
monashcollege.edu/privacy.html
All documents provided to Monash College Pty Ltd become the property of the College and will not be returned to you. You have a right to access personal information that Monash College Pty Ltd holds about you, subject to any exceptions in relevant
legislation. For information about how to seek access to your personal information or about the handling of your personal information including how a complaint will be handled, please refer to the privacy policy at monashcollege.edu/privacy.html.
CRICOS provider: Monash University 00008C, Monash College Pty Ltd 01857J. ABN 64 064 031 714
3
14P-1228
For enquiries please contact the Monash College Pty Ltd Privacy Officer by email at [email protected] Monash College reserves the right to revise student fees from time to time. Applicable refund policies are accessible online at monashcollege.
monash.edu/how-to-apply/our-policies-you.html. By submitting this application, you warrant that you have read, understood and agree to the refund policies.