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R REQUEST F FOR C CHANG GE

T TO ELECT TRONIC CONFIR RMATION OF ENR ROLMENT T (ECOE)


Di ivision of Studen nt Administration n, Building X-00 05, 121 Marcus C Clarke Street, C Canberra ACT 02 200 Australia E E: policy.regs@anu.edu.au T: +61 2 6125 143 36 F: +61 2 6125 7535 W: www.anu.edu.au/ w /ieo CRICOS P Provider Numbe er: 00120C

INSTRUCTIO ONS 1. 2. 3. 4. Student MUST com mplete section ns 1, 2, 3 and 4 urn the form to o the college, f for completion n of section 5 Student MUST retu ege MUST com mplete section n 5 and send th he form to the Policy Officer r for completion of section 6 Colle Students will be se ent their new E ECOE by emai il. PLEASE PRINT ALL ANSWERS CLEA ARLY.

1. PERSONA AL DETAILS Family Name: : Telephone(H) ): Fax: Mailing Addre ess(in Australia a): Suburb: 2. VISA DETA AILS Country of birt th: Passport num mber: Date of Bir rth: Cou untry of citizens ship: VISA expiry y date: Given Nam me: Mobile Nu umber: Email Add dress: Uni ID Num mber:

State:

Postc code:

If you are app plying for a new w visa, in what t country will y you be lodging your applicati ion: 3. REASON F FOR CHANGE E I have cha anged my program. New pr rogram numbe er: My visa w will expire befo ore I finish my program. Reason: I did not p previously hav ve an electronic Confirmation n of Enrolment t. I have completed my pr rogram more t than one mont th prior to my v visa expiry dat te. 4. STUDENT DECLARATIO ON I certify that th he information supplied by m me on all parts of this form is s complete and d true. Signature . Date ../ ./ 5. COLLEGE APPROVAL ( (All sections to o be completed by a Delega ated Officer) Delegated Au uthority 1 Status Grante ed (if any) . Total units req quired for completion . Expected com mpletion date /./ . Name Signature . Date ../../ 6. INTERNAT TIONAL OFFIC CE APPROVA AL New ECOE nu umber . . Signature: Date e ././ . Dele egated Autho ority 2 Stat tus Granted (if f any) . Tota al units require ed for completion . Expected complet tion date / /./. Nam me Sign nature . Date ../ /../ New pro ogram name:

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