Institute of Australian Education Application Form
Study in Australia
Previous tertiary education in Australia
International
National
Personal Information
Salutation *
First Name *
Last Name *
Date of birth *
(dd)
(mm)
(yyyy)
Gender *
Male
Female
Nationality (as shown on passport) *
Email address *
Confirm email address *
Home Phone *
(
)
Work Phone
(
)
Mobile (for sms course offer updates)
(
)
Fax
(
)
Visa Information
Passport Number
Expiry Date
(dd)
(mm)
(yyyy)
Country of Issue
Visa Number
Visa Expiry Date
(dd)
(mm)
(yyyy)
Contact Information
Mailing Address
House/Unit Number *
Street Name *
Suburb/Town *
State *
Postal Code *
Country *
Home Address
Same as mailing address
House/Unit Number
Street Name
Suburb/Town
State
Postal Code
Country
Study Preferences
Course Name
Provider
Cost
First Preference *
Second Preference
Third Preference
Specified
Preferred study commencement date *
Semester
(1 or 2) OR
(mm)
(yyyy)
Preferred length of study *
1 - 10 weeks
10 - 50 weeks
1 - 5 years
Previous Education and Qualifications
INTERNATIONAL STUDENTS ONLY
# Please note: the following qualifications are only deemed valid if completed in the last five (5) years.
Please check "other" and enter details of any qulifications completed prior to this cut-off
Certifications
Score
Year Completed
#GCE 'O' Levels
#IELTS
#TOEFL
#CUTE
#ESL/ELACS
NATIONAL STUDENTS ONLY
# Please note: you must have passed TEE English with a minimum C grade (50%) to apply to University
Score
Year Completed
English Competancy
TER
ALL STUDENTS
Course / Qualification
Course Name
Institution Name
Year Enrolled
Year Completed
Relevent Employment History
From
To
Employer
Occupation details
Declaration
I hereby consent and authorise IAE P/L & EMA Pty Ltd to forward the information above and other information provided to the education providers in order to facilitate my enrolment and acceptance by any Cricos or EMA P/L chosen educator(s) and I acknowledge that IAE P/L and or EMA P/L may receive consideration from the educator that receives my referral. I hereby declare that the information provided on this application is correct. I authorise IAE Pty Ltd & EMA Pty Ltd to obtain official records if necessary, from TISC, VTAC, UAC, QTAC, SATAC, UT and/or any other education institution attended by me. I understand that if any information provided is false, this application may be cancelled and I may be liable for the referral fee.
I Agree:
Please send, print this form and fax to IAE on (+618) 9388 8669, or post to IAE Student Services, 10 Gregory Street Wembley, Perth, Western Australia, 6014
