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PERSONAL DETAILS (continued)
Have you visited or studied in Australia previously?

Yes

Have you ever been refused a visa for entry into Australia?

No
Yes

Have you breached any visa conditions?
No

Yes

No

If yes, please provide reason:

Please provide details of family immigration history.
Are you married?

Yes

No
Yes

Is your spouse already in Australia?

NoWhat visa does your spouse hold?
What is the expiry date of your spouse’s visa?
Please provide details on all dependents who will be included in your student visa application, including their date of birth.
Name:

Date of birth: D

D/M M/Y

Y

Name:

Date of birth: D

D/M M/Y

Y

Name:

Date of birth: D

D/M M/Y

Y

Name:

Date of birth: D

D/M M/Y

Y

If youhave more than four dependents, please attach a separate sheet with any remaining dependents details.
Yes

Do you have a criminal background?

Do you have a disability?

Yes

No

If yes, please provide relevant details:

No

Note this is for support purposes only and will not affect the outcome of your application.

Do you have a medical or health-related issue that may prevent astudent visa being issued?

Yes

No

Please refer to www.immi.gov.au/allforms/health-requirements/meeting-health-req.htm

If yes, please provide details:

Have you been granted a scholarship?

Yes

No

Scholarship name:

e.g. AusAID, government or any other kind of scholarship

COURSE PREFERENCES
Please enter the correct course name as per Course Search:http://www.international.swinburne.edu.au/courses/
TAFE, UNDERGRADUATE OR POSTGRADUATE COURSES

CAMPUS

INTAKE

YEAR

e.g. Bachelor of Business

e.g. Hawthorn

e.g. February

e.g. 2011

1
2
3
FOUNDATION STUDIES

DEGREE TRANSFER

INTAKE

YEAR

Please tick

Please tick

Please tick

e.g. 2011

Business

Diploma of Business (UniLink)

February

Design

Diploma of Design (UniLink)June

Information Technology/Multimedia

Diploma of Information Technology (UniLink)

October

Science/Engineering

Diploma of Engineering (UniLink)

How is this course/s relevant to your prior studies or your future career aspirations?
Please attach a Statement of Purpose (not more than 300 words) detailing reasons for any change in career, gaps in study or work experience andintention after
completion of study in Australia. Please attach referee reports, CV or work experience details, and for some design programs, portfolio. Please refer to CourseSearch
for further details in relation to portfolio requirements: www.international.swinburne.edu.au/courses

COURSE PREFERENCES (continued)
Have you ever been excluded from any previous institution?

Yes

No

Ifyes, please provide details of the reasons and institution/country:

Please note that due to Swinburne’s obligations under Australian migration, trade and sanction laws, even if you meet Swinburne’s academic entry and selection
criteria, it is possible that Swinburne may not be able to offer you a place due to additional non-academic criteria required to meet Swinburne’s legal requirements,
whichare applied at Swinburne’s sole discretion. For further information please see:
(1) Migration Act 1958 (Cwth)
(2) Migration Regulations 1994 (Cwth)
(3) Autonomous Sanctions Act 2011 (Cwth)
(4) Autonomous Sanctions Regulation 2011 (Cwth)
Refer to http://www.immi.gov.au
Refer to http://www.dfat.gov.au/

ENGLISH LANGUAGE PROFICIENCY
Have you taken an English proficiency test within the last12 months?

Yes

No

Date of test: D

D/M M/Y

Y

If yes, please attach a certified copy of your results, or submit a certified copy as soon as possible.
Test type:

Result:

(e.g. IELTS)

(if known)

Do you intend to undertake English language studies (ELICOS) at Swinburne?
Number of ELICOS weeks:

5

10

15

20

25

Yes

30

If yes, approximate start...
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