APPLICATION FOR ADMISSION

TO A COURSEWORK PROGRAM
INTERNATIONAL APPLICANTS ONLY

1. AGENT DETAILS

Address Line 1 #19, Dempster Street, West Wollongong, Wollongong, NSW

Address Line 2

Address Line 3

Town / City Wollongong State / Province NSW

Country Australia Postcode / ZIP 2500

Counsellor name Nittu Hunjan Counsellor email nittu.hunjan@idp.com

2. PERSONAL DETAILS

Title Mr Family name Pinto

First name Alren Other given name(s)

Date of birth 10/10/1992 Gender Male Female Indeterminate

Email address afpinto92@gmail.com

Have you previously enrolled at CQUniversity? Yes No Student number

Are you applying for a change of program? (if yes, Credit Transfer Form attached) Yes No

3. ADDRESS DETAILS

What is your permanent address outside of Australia?

Address Line 1 ALRIA, Pinto Compound, Kottar Cross, Mangalore, Karnataka

Address Line 2

Address Line 3

Town / City Mangalore State / Province Karnataka

Country India Postcode / ZIP 2500

Home telephone Mobile telephone +61420228134

What are your current contact details? Same as permanent address above
Address Line 1

Address Line 2

Address Line 3

Town / City State / Province

Country Postcode / ZIP

Home telephone Mobile telephone

4. NATIONALITY & VISA DETAILS

What country are you applying from? Australia

Have a passport? Yes No Number H8423411 Expiry 07/04/2020

Visa code

Do you have any previous immigration history such as visa applications/refusals/visa grants? Yes No

IF YES > Have you previously had a visa granted or made a visa application? Yes No
Additional information:

IF YES > Have you previously had a visa application refused? Yes No

Visa refusal letter and decision record attached (if yes).

5. COURSE PREFERENCES

Course Master in Engineering Management

Campus Sydney Intake July, 2017

Code CC74 Course type Engineering

Are you applying through a packaged pathway provider or an SVP partner? Yes No

Partner institution

6. ENGLISH LANGUAGE PROFICIENCY

First language? English English test? Yes No Name of test IELTS

Reference Secret number Date of test 10/07/2016

Overall score 8.0 Listening Reading

7. EDCUATION BACKGROUND (SUMMARY)

Qualification 1
Institution

Qualification

Completion date

Qualification 2
Institution

Qualification

Completion date

Qualification 3
Institution

Qualification

Completion date

Note: Academic certifications, transcripts & CV are attached

Applying for credit transfer or Recognition of Prior Learning as a result of previous study? Yes No

Note: Translated copies of course and subject outlines attached.

9. EMPLOYMENT HISTORY

Employment 1
Employer

Job description

Start date End date

Employment 2
Employer

Job description

Start date End date

Employment 3
Employer

Job description

Start date End date

Employment 4
Employer

Job description

Start date End date

Employment 5
Employer

Job description

Start date End date

Note: Documentary evidence is attached.

10. FINANCIAL DETAILS

How will you be funding your studies whilst living in Australia? Name of sponsorship / loan provider:

Note: Financial documents attached.

11. UNIVERSITY SCHOLARSHIPS

I am applying / I would like to apply for a CQUniversity Scholarship? Yes No

Name of scholarship: Vice Chancellors Scholarship Placeholder Placeholder

12. OVERSEAS STUDENT HEALTH COVER (OSHC)

It is a requirement of the Australian Government that you maintain OSHC for the duration of your visa

Type of cover required Name of OSHC provider

Have a disability, impairment or long-term medical condition which may affect your studies? Yes No

Area of impairment: Hearing Learning Medical Mobility

Vision Other:

13. STUDY STATEMENT

Why do you want to study in Australia?

Why did you choose CQUniveristy?

How do you believe your chosen program will contribute towards your current or chosen career path?

What do you plan to do when you return to your home country?

What are your current personal circumstances in your home country ie family / relationships?

Do you already have family living in Australia? Yes No

Please provide details on the family members who are already living in Australia.

14. ALTERNATE STUDY STATEMENT

Why have you chosen Australia as a study destination?

Why did you choose CQUniveristy?

Have you explored a less expensive program alternative in your home country?

How do you believe your chosen program will increase your chances in the labour market in your home country?

Provide a detailed explanation of your previous employment history, and indicate its relevance to your future study.
 How do you believe your chosen program will contribute towards your current or chosen career path?

What do you intend to do when you return to your home country?

Do you have any previous immigration history such as visa applications/refusals/visa grants? Yes No
Please give details of your immigration history.

What are your personal circumstances in your home country ie family relationships? Why family members will
accompany you to Australia, and what is their relationship to you?

Do you currently have family living in Australia? Yes No

Please provide details on the family members currently living in Australia and their relationship to you.

Is there any further information that you would like to add to support your application?

15. APPLICANT DECLARATION

I agree Name / Signature

16. AGENT DECLARATION

I agree Name / Signature