Study Abroad and Exchange Application Form

Study Abroad
and Exchange
Application form
REPRESENTATIVE STAMP
Please use a Ballpoint Pen to fill out this form
1. Personal details (use block letters)
Mr
Mrs
Ms
Miss
Sex
Family Name
Former Name (if applicable)
Male
Female
First Names
Date of Birth
D D /M M/ Y Y Y Y
Do you have any disabilities/conditions that you think Macquarie University should be aware of? Yes
No
Please attach a letter explaining the support required.
Major or Course of study at home institution
Contact Address for Correspondence
Street Address
Town/Suburb
Postcode Phone (h)
E-mail
State/City
Country
Fax
PERMANENT ADDRESS IN HOME COUNTRY (ONLY IF DIFFERENT FROM THE ABOVE ADDRESS. IF THIS ADDRESS CHANGES, PLEASE ADVISE THIS OFFICE IMMEDIATELY)
Street Address
Town/Suburb
Postcode Phone
State/City
Country
Fax
2. CITIZENSHIP AND ENGLISH LANGUAGE PROFICIENCY
Country of Citizenship (as shown in your passport)
Country of Birth
Is English your first language? Yes
No
My first language is
If no, I have attached evidence of my English Language Proficiency
IELTS Score
TOEFL Score
For information on English language requirements, visit www.international.mq.edu.au/study/apply/studyabroad
www.international.mq.edu.au
CRICOS provider no. 00002J
3. ACADEMIC BACKGROUND
At which institution are you currently studying?
Country
Please give full details of your previous study. Please attach: 1) Your official transcript 2) A one page statement of purpose
Other qualifications
Qualification/Award
School/Institution
Country
Duration
Date award conferred
4. PROPOSED STUDY PROGRAM
I am intending to study:
Starting Date:
One Semester
Semester 1 (February-July) Full Year
Semester 2 (July-December)
Year
*Important: Course Approval will be assessed on the basis of the transcripts that you provide and final enrolment will be completed upon arrival.
Semester 1 – (February – July)
Subject Code
Subject Name
Course Approval (Official Use Only)
Subject Name
Course Approval (Official Use Only)
1
2
3
4
5
6
Semester 2 – (July – December)
Subject Code
1
2
3
4
5
6
Internships
I am interested in the internship program
To confirm your eligibility and apply for an internship online, head to our website: www.international.mq.edu.au/internships
Volunteer
I am interested in participating in a volunteer activity whilst studying at Macquarie
5. DECLARATION
I wish to be considered for enrolment as an international student in a course at Macquarie University and declare that the information submitted is correct and complete. I have read and consent
to the University’s Freedom of Information Policy, as set out at at www.ras.mq.edu.au/documents/mufoipolicystatement.pdf. I understand the University may obtain official records from any
school, university or other tertiary institution previously attended by me for the purpose of verification of my supporting documents. All documents submitted become the property of the
University and will not be returned. I understand that the University reserves the right to vary or reverse any decision made on the basis of incorrect or incomplete information or fraudulent
documentation. I recognise that it is an offence to submit fraudulent documentation in support of an application for the purpose of gaining admission to the University. Where fraudulent
documents are detected, I understand that my application will be rejected. If an offer has been made, it will be withdrawn. If a visa has been issued, the Department of Immigration and
Citizenship (DIAC) will be notified. All matters concerning fraudulent documentation will be reported to the relevant Government and statutory authorities, including NSW Police, Department of
Immigration and Citizenship (DIAC) and Independent Committee Against Corruption (ICAC). I authorise the University to release any personal information held about me to any other educational
institution or authority to verify my student conduct, academic record or supporting documentation for the purpose of determining my eligibility for admission to the University. I herewith
give the University permission to provide my address and details of enrolment to the Department of Immigration and Citizenship (DIAC) and the Department of Education, Employment and
Workplace Relations (DEEWR), should I enrol at Macquarie University. I am able to make appropriate arrangements to fund my studies. I have read and understood the University’s tuition fee
refund policy and conditions set out at www.international.mq.edu.au/fee_policy. I agree to comply with Macquarie University’s rules of admission and enrolment. I agree to tell the University
immediately if there is any change to the information I have given in this application. I have attached all relevant documents, including my official transcript and one page statement of purpose.
Signature
Date
Unsigned applications will not be processed. Applications must be signed by the applicant personally.
Third parties must not sign on the applicant’s behalf.
PLEASE RETURN THIS FORM AND THE NECESSARY ATTACHMENTS TO:
Macquarie Abroad, Macquarie International
Building E3A, Macquarie University
North Ryde NSW 2109, AUSTRALIA
or Fax: +61 2 9850 7733
D D /M M/ Y Y Y Y