ENROLMENT FORM

PERSONAL DETAILS

Title
MrMrsMsMissDrOther

Given Name *

Family Name *

Gender *
MaleFemaleOther

Date Of Birth *

Contact Number *

Your Email *

Are your applying from Onshore (in Australia) or Offshore (outside of Australia)?
OnshoreOffshore

YOUR ADDRESS

Street Address *

Suburb

City *

State

Country *
AustraliaAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaArubaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCabo VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabwe

Postcode

TRAVEL DOCUMENT INFORMATION

Please provide us with a scanned copy of your travel document (passport). You can submit this later if you wish, but your application will process faster the earlier you provide it.

Passport Number *

Country Of Birth *
AustraliaAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaArubaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCabo VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabwe

Country Of Issue *
AustraliaAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaArubaAustriaAzerbaijanBahamas, TheBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurmaBurundiCambodiaCameroonCanadaCabo VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzechiaDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoriesPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVenezuelaVietnamYemenZambiaZimbabwe

Nationality *

Are You In Australia On A Visa? *
YesNo

If yes, what type of visa?

Visa Number

ENGLISH PROFICIENCY

Do you have proof of English proficiency? (IELTS, PTE, university study, etc.) *
YesNo

If yes, please attach any proof of English proficiency you may have.

If no, please take our online English Placement Test after applying so we can assess your level.

EDUCATION HISTORY

Please provide any documentation your highest education qualification achieved.

Are you currently enrolled at another institution in Australia? *
YesNo

If yes, which institute?

Which program?

When do you expect to finish?

Is a letter of release required?
YesNo

If no, what is the name your previous institution of study (this could be your secondary school, college, university, technical school, English school)?

How long did you study there?

OVERSEAS STUDENT HEALTH CARE(OSHC)

It is a requirement for all international students arriving in Australia on a student visa to have OSHC for the duration of their visa.

Do you need Liberty International College to arrange your OSHC for you? *
Yes, for me (single)Yes, for us (couple)Yes, for us (family)No, I am responsible for arranging my own insurance cover for the duration of my visa

ACCOMMODATION

Do you require assistance with accommodation? *
YesNo

If yes, how many weeks?

Approximately, when would you want to move in?

Do you require a single (private) or shared accommodation?
SingleShared

REQUEST FOR DISABILITY SUPPORT

If you are requesting disability support, and have a disability that may affect your learning (e.g. hearing, or vision impairment, health, mobility, etc.) please provide official supporting documentation (in English) about the nature of your disability and the impact it will have for your education in Australia

Do you require disability support? *
YesNo

If yes, please specify what type of support you will need and your disability

COURSE SELECTION

Please indicate what course(s) you are interested in. Please select all that apply. (* New Courses Scheduled for 2018)  IELTS Foundation IELTS Advanced Certificate III in Early Childhood Education and Care Diploma in Early Childhood Education and Care Certificate III in Carpentry Certificate IV in Building and Construction (Building) Diploma of Building and Construction (Building) Certificate III in Carpentry * Certificate III in Concreting * Certificate III in Steelfixing * Certificate III in Formwork" * Certificate III in Floor And Wall Tiling * Certificate III in Electrotechnology * Diploma of Project Management * Diploma of Business * Advanced Diploma of Leadership And Management

How did you find out about us? *

Did you receive any assistance from an Agency? If so, which agency?

PAYMENT OPTIONS & INFORMATION

Would you like to pay in full or use a payment plan? *
I will pay in fullI will pay in 2 blocksI will pay in 4 blocksI will pay in 8 blocks

We will send you more information on hpw to pay based on your preferred method of payment. How would you like to pay?
Electronic Transfer or Direct DepositCash PaymentDirect Debit

EMERGENCY CONTACT

Name:

Relationship to student:

Complete Address:

Phone Number:

Email:

STUDENT DECLARATION

I have read Terms and Conditions as outlined on page 2*
YesNo

I have reviewed the Refund Policy*
YesNo

YOUR SIGNATURE