Application form

Menzies OBA Preparation Program

1. PERSONAL DETAILS

Title

  

Family name (as in passport)

  

Given name(s) (as in passport)

  

Date of birth

Gender ☐ Male  ☐ Female ☐ Other or Non-disclosed

Nationality (as per your passport)

  

Phone/Mobile (with country code)

  

Email Address

  

Address in Home Country

Address

  

Suburb / Town

Postcode:

Country

  

Address in Australia (if known)

Address

  

Suburb / Town

Postcode:

Country

  

Emergency Contact Details

Contact Name

Phone Number

Mobile Number

Relationship

Medical Conditions

Do you have a known disability or medical conditions? (e.g. intellectual, hearing, vision, etc.) ☐ YES ☐ NO

If YES (give details and contact our admin team)

2. PASSPORT AND VISA DETAILS

Country of Birth

  

Citizenship

  

Passport Number



3. ENGLISH PROFICIENCY





Please provide certified copies of meeting the English language skills requirement as outlined here: https://www.nursingmidwiferyboard.gov.au/Registration-Standards/English-language-skills.aspx

IELTS Score TOEFL Score PTE Score Other (please specify)

(Overall)



Test Date: __________
 

e Specify)

    

4. INTAKE MONTH

Month _________________________ Year_________________________

5. EDUCATION AGENT DETAILS (If applicable)

Who is your Education Agent?

Agent Name

  

Agency name

  

Address

  

I authorise the agent selected to act on my behalf: ☐ Authorise education agent

Agent declaration

I am satisfied that the applicant is a genuine student and I recommend them for admission to MENZIES Institute of Technology. I am satisfied that the applicant has access to sufficient funds to cover tuition, travel, living costs for themselves and any dependants. I confirm that the supporting documentation provided with this application are the true copy of the originals which are/were sighted by me and can confirm their authenticity and genuineness.

Agent Signature: ________________________ Date: _______________________

8. STUDENT DECLARATION

  1. I declare that the information contained in this application and the supporting documentation is true and correct. I understand giving false or misleading information is a serious offence under state and/or federal law in Australia.

  1. I understand that if MENZIES Institute of Technology forms the opinion that I am not a Genuine Temporary Entrant, they may refuse to assess my application, withdraw an offer or cancel my confirmation of enrolment.

  1. I declare that I have read and understand the information related to MENZIES Institute of Technology admissions requirement, tuition fees, course information and refund policy on www.menzies.vic.edu.au

  1. I agree to advise MENZIES Institute of Technology immediately if there are any changes to the information I have provided in this application.

  1. I understand that MENZIES Institute of Technology have the right to vary or reverse any assessment made on the basis of incorrect, incomplete, false or misleading information which I have provided.

  1. I understand that by completing this application, I am giving written consent to MENZIES Institute of Technology verify the information supplied by me in this application.

  1. I declare that I have access to the funds required to study at MENZIES Institute of Technology for the length of my course including course/tuition fees and living expenses for myself and my dependents.

  1. I agree to allow MENZIES Institute of Technology to check my visa entitlements via DHA Visa Entitlements Verification Online (VEVO) System.

  1. I have read and understood the above conditions and accept them in full.

________________________________ _______________________

Applicant Signature Date

_______________________________

Applicant Name

 

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