+

Queensland University of Technology

Student Business Services Victoria Park Road Kelvin Grove Qld 4059 Phone +61 7 3138 2000 Fax +61 7 3138 3529 www.qut.edu.au/international CRICOS No. 00213J ABN 83 791 724 622
ID No
Representatives stamp / date received

Office use only

1109

Application for Admission to QUT as an International Student

Using this form
1. Please complete all sections and print neatly in BLOCK LETTERS, scan and submit to qut.intadmission@qut.edu.au 2. Do not use this form if you are a citizen of Australia or New Zealand or a permanent resident of Australia or the holder of an Australian permanent visa. 3. You will need to pay a non-refundable application fee of AUD$55 (AUD$50 + 10% GST) when you submit this form (complete section 11 Payment of application fee). 4. There can be additional admission entry requirements such as a portfolio, audition or interview if you are applying for a course in the Creative Industries faculty. 5. Please note: You must be at least 17 before commencement of your course.

1. Personal details
Title (Mr, Miss etc) Surname or family name Given names

MRS
Male

EBRON
Female Date of birth

JONALYN

2
day

1 / 1
month

2 / 1
year

3 Current age
Current address

7 Citizenship

FILIPINO

Permanent address in home country

(If you are a current QUT student, all correspondence will be sent to your student email address.)

5324 MAAHAS, LOS BANOS, LAGUNA, PHILIPPINES

Telephone
Country code Area code Number

Telephone
Country code Area code Number

Cell/mobile Fax

(63)
Country code

(049)
Area code

915-383-7183
Number

Cell/mobile
Country code Area code Number

Fax
Country code Area code Number Country code Area code Number

Email

jonalyne@yahoo.com
Yes No If yes, please quote your QUT student ID number

Have you applied to QUT before?

N
* Limited courses available. Please refer to studyfinder.

2. Preferred course of study

Proposed year of entry Course code 1. 2. 3.

2 0

1 3

Proposed teaching period of entry Feb Name of course

Jun/Jul

Oct/Nov*

Course major /specialisation /ED38 teaching area nomination

(you must complete this section)

3. QUT International College courses

Course (Please specify Bachelor program and Major)
QC02 Foundation / QC04 Extended Foundation IT10 / BS40 / IF06 University Diploma
+ Bachelor of + Bachelor of Major Major

4. Current passport and visa status

Do you have a current passport Yes Are you currently in Australia? Yes

g g

Include copy of passport. Student

No

2 5 / 0 4 / 2

Date passport available (dd/mm/yyyy)

What type of visa do you have?

Which institution are you studying at ?

(You must include a copy of your current Australian visa with your application)

Other visa

What visa type?

No

I will apply for a student visa.

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Please give details of all your secondary education and other post-secondary courses that you have attended or are currently studying. You must attach certified copies of your academic results, including English translations where necessary. QUT GMAT code is 1677. Original academic records or portfolios will not be returned. . Course Name of qualification or examination Attendance dates completed? Name of school or institution (eg SPM, STPM, GCE O and A level, BSc, etc) month/year to month/year yes/no

5. Educational qualifications

AMA COMPUTER COLLEGE LAGUNA COLLEGE OF BUSS AND ARTS

MS IN COMPUTER SCIENCE BS IN COMPUTER SCIENCE

SEPT 2006 MAR 1994

YES YES

Do you intend to apply for exemptions (credit) on the basis of previous tertiary study? Have you ever been excluded from previous tertiary study? If yes, please attach details. If you have previously completed a degree course at QUT do you wish to be considered for the QUT alumni scholarship for a subsequent QUT degree course?

Yes Yes Yes

No No

This scholarship offers a 20 per cent reduction in the first semesters tuition fees. To be eligible applicants must not use an agent at any stage during the application process, full details are at www.qut.edu.au/international-students/applying/step-4-check-costs-and-scholarships

6. English proficiency
Please tick appropriate boxes I have taken an: IELTS (academic) test TRF Test Report Form number Registration number /
day month

TOEFL test (QUT TOEFL code is 9778). I will take a test on:

/
year

7. Employment details

You MAY be exempt from taking a formal test if your secondary or tertiary studies were conducted entirely in English and you have passed an English language or one or more Communication subjects. Please refer to English Language www.qut.edu.au/international-students/applying/ step-3-check-you-meet-the-entry-requirements/ for further information about the minimum level of English proficiency requirements for admission to QUT courses.

Some postgraduate courses, eg Master of Business Administration, require work experience for course admission. For QUT admission entry requirements refer to Studyfinder at www.qut.edu.au/study Provide certified/originals of dated work experience statements from employers or other appropriate evidence. Years Full-time/ ....... to ....... part-time Description of occupation and experience Employer

Applicants for ED26 and NS40 only: I certify that I have the necessary qualifications to be professionally registered in my home country as a teacher/nurse. If yes, provide certified evidence of registration.

Yes

No

8. Supporting statement / extra information

You may wish to provide extra information to support your application. Also, if you have any disability that may affect your learning (eg vision, health, mobility) you should provide early advice so the University may assist you. Please attach additional information on a separate sheet.

9. Privacy statement
The information collected on admission forms is used to determine whether you may be offered admission to the University. If you enrol as a student of QUT, the information you have provided on this admission form will be used to administer your enrolment, to offer other services to you and to provide statistical information to the Commonwealth Government as required by law. For full details of QUTs practices regarding student information and privacy www.qut.edu. au/privacy

10. Declaration (all applicants must sign)

By submitting this application I agree to comply with the statutes and rules of Queensland University of Technology that apply to me and as documented on the QUT website available at www.mopp.qut.edu.au/Appendix/. I further agree that I am subject to and must comply with any policies or procedures of the University governing my conduct as a student, and academic matters affecting my studies, including but not limited to, the QUT Student Code of Conduct www.mopp.qut.edu.au/E/E_02_01.jsp and the procedures for management of student discipline www.mopp.qut.edu.au/E/E_08_01.jsp. I declare that to the best of my knowledge the information supplied by me is true, correct and complete in every respect. I acknowledge that the submission of false, incorrect, incomplete or misleading information may result in cancellation of my enrolment or delays in processing. I acknowledge that I am responsible for the payment of all student fees and charges applying to my admission and study at QUT. QUT shall not be liable for any failure to provide services (including lectures, tutorials or examination results) or any teaching or other materials to students where such failure is due to circumstances beyond QUTs control. Such circumstances include, but are not limited to, natural disasters, malicious damage, outbreak of pandemic disease, industrial action or strikes, acts of war or acts of God. I acknowledge that it is my responsibility to provide all necessary documentary evidence of qualifications or experience. I authorise QUT to verify such records through QualSearch or grant my consent for other educational institutions, admissions centres, government bodies or employers to disclose information about my qualifications and experience directly to QUT. I have read and understood the Universitys admission procedures at www.qut.edu.au/international/applying, admission requirements at www.qut.edu.au/internationalstudents/applying/step-3-check-you-meet-the-entry-requirements/, privacy statement, and the international tuition fee and refund policy and its conditions at www.student. qut.edu.au/fees-and-finances/study-costs/fee-schedule. I am aware of the likely costs of my stay in Australia and I understand that neither QUT nor the Australian Government is obliged to help me if I require financial assistance. I understand that if I have children between the ages of 6 to 15 who will accompany me in Australia, I will be required to pay compulsory school fees. I understand that any information I provide to QUT may be made available to Commonwealth and State Government agencies, and to the Fund Manager of the ESOS Assurance Fund, pursuant to obligations under the ESOS Act 2000 and the National Code.

Applicant signature Parent / Guardian signature

(if applicant under 18)

Date day

month

year

If you are using the services of a formal QUT representative to process your application, all communication about your application will occur with that representative.

11. Payment of application fee Application fee TOTAL: AUD$55.00 g To pay application fee visit http://qutpay.qut.edu.au and select New International Student Payments.

Please quote your QUTPay transaction number

(Transaction number can be found on transaction receipt)

Do NOT send cash or personal cheques to QUT.

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Print a copy of your completed form. Please sign before lodging.