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SECTI
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venname:

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efer
redname: Sex: ☐ Male ✓ Femal
e
01/
10/
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gybagongpagasaQuezonci
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Ar
eyoucur
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i
a? ☐ Yes ✓ No I
fyes,
stat
ecur
rentpr
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ow:

SECTI
ON2.VI
SADETAI
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ipi
no Phi
l
ippi
ne
Passpor
tnumber
: Ci
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p: Count
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isa? Yes ☐ No ✓ IfYes,whichv
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ypeand
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I
fNo,
whi
chv
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yfor
:✓St
udent☐Vi
sit
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e:
☐ Wor
ki
ngHol
i
day ☐Ot
her

Hav
eyouhadav
isar
efusal
int
hepastf
rom Aust
ral
i
a,UK,
Canada,
NewZeal
andort
heUSA?☐Yes☐No
Doyouint
endt
obri
ngspouseorchi
l
drentoAustr
ali
a?✓Yes☐NoIfYes,
howmanyf
ami
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ymember
s?
1
SECTION3.COURSEPREFERENCE(Tickeachcour
seyouwantt
ostudy
)
✓ 091501-ELI
COS(
Gener
alEngl
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CRI
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CRI
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COSCode0101975]
SECTI
ON3A.PACKAGEDCOURSESMAI
NSTREAM (
Tickanyone)
BSB51918-Di
plomaofLeadershi
pandManagement[CRI
COSCode099545D]+
✓ BSB50215-Di
plomaofBusiness[
CRICOSCode088122G]+
BSB61015-AdvancedDi
plomaofLeader
shi
pandManagement[
CRICOSCode095336A]

BSB51918-Di
plomaofLeadershi
pandManagement[CRI
COSCode099545D]+
☐ BSB50215-Di
plomaofBusiness[
CRICOSCode088122G]+
BSB60215-AdvancedDi
plomaofBusiness[
CRI
COSCode0101975]

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 CHC43015-Certi
fi
cateI
VinAgei
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COSCode094835A]+
☐ BSB51918-Di
plomaofLeader
shipandManagement[CRI
COSCode
099545D]+
BSB61015-AdvancedDipl
omaofLeader
shipandManagement[
CRICOSCode095336A]

I
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 CHC43015-Certi
fi
cateI
VinAgeingSupport[CRI
COSCode
☐ 094835A]+CHC53315-DiplomaofMentalHealt
h[CRICOS
Code0102145]+
BSB61015-AdvancedDipl
omaofLeadershipandManagement[
CRICOSCode095336A]
I
fyourselect
edcour
seisnotavai
labl
e,doyouhaveanyothercour
sepr
efer
ence?

Commenci
ngi
ntakeandy
ear
: ☐Januar
y ☐Apr
il ☐ Jul
y ☐ Oct
ober
Ar
eyouappl
yi
ngf
orRecogni
ti
onofPr
iorLear
ning(
RPL)orCr
edi
t ☐ Yes☐No
Tr
ansf
er?
SECTI
ON4.ENGLI
SHLANGUAGEPROFI CIENCY

Youar
erequi
redt
omeetoneoft
hef
oll
owi
ngEngl
i
shl
anguager
equi
rement
s:

☐ I
ELTSorequi
val
ent(
Pleaseat
tachev
idence)

Over
all
I
ELTS
Band Li
steni
ng Readi
ng Wr
it
ing Speaki
ng
Test
Scor
e
Resul
ts
Engl
ishequi
val
ency:
Youhavest
udi
edatsecondar
yorpost
-secondar
ylev
elwi
thEngl
i
shasl
evel
of
☐ i
nstr
ucti
on(att
achevi
dence)

SECTI
ON5.PREVI
OUSQUALI
FICATI
ONSANDEMPLOYMENT

Ar
eyoucur
rent
lyst
udyi
nginAust
ral
i
a?☐Yes,
☐No.I
fyouhav
eacur
rentCer
ti
fi
cat
eofEnr
olmentf
rom anot
her
pr
ovi
der
,pl
easeatt
achacopy.
Doesyourcour
sesel
ect
ioncor
respondwi
thy
ouracademi
cand/
orempl
oyment
Yes ☐ No ☐
backgr
ound?

Att
achcopi
esofyourtr
anscri
ptsorstatementsofresul
tsf
orseni
orsecondar
yandpost
-secondar
yst
udy
.Document
s
noti
n
Engl
ishmustbeaccompaniedby‘cer
tif
ied’
transl
ati
ons.
ACADEMI
CHI
STORY: Secondar
yst
udi
es Seni
orsecondar
yst
udi
es Bachel
or’
s
degree

Nameofqual
i
ficat
ion

Yearcompl
eted

School
/uni
ver
sit
y

I
fnotcompl
etedar
eyouawai
ti
ngr
esul
ts? ☐ Yes☐No ☐ Yes☐No ☐ Yes☐No

Doy ouhaveaLawsonCol
legeorot
her ☐ Yes☐No ☐ Yes☐No ☐ Yes☐No
scholar
shi
p?
OREMPLOYMENTHI STORY:

Dat
e
Nameofempl
oyer Posi
ti
o
n Fr
om To

Youmustat
tachev
idenceofy
ourempl
oymente.
g.l
ett
erofr
ecommendat
ionorpay
sli
ps.

BREAKSINEMPLOYMENTHI
STORY:
Pleaseat
tachsepar
atedocumentexpl
aini
nganybr
eaksi
nst
udyand
employ
menthi
stor
y.

STATEMENTOFPURPOSE
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I
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 Statementofpurposei sani mpor t
antpartofy ourappli
cati
onasitwil
lhelpyouwi t
hyourappli
cat
ionforstudyat
LawsonCol l
egeandy ourvi
saappl icati
on.Pl
easet hinkcar
eful
lyaboutyourpur
posebef or
eyoustartt
hissecti
on.
Please att
ach awr it
ten statement .Yourst atementshoul dincl
ude,buti s notrestr
ict
ed tothe fol
lowing
i
nformation:
• Whyy ouar
eappl yi
ngfort hecourse
• Whatbenef i
tst hecoursewi l
lhavetowardsyourcareer
?
• Whatt heempl oymentout comeswi ll
beiny ourhomecountr
y

SECTI
ON6.STUDENTSUPPORTSERVI
CES

Doy
ouhol
dOv
erseasSt
udentHeal
thCov
er(
OSHC)
?☐Yes☐No I
fYes,
expi
rydat
e( )

I
fNo,
whatt
ypeofcov
erdoy
our
equi
re? ☐Si
ngl
e☐Dual
fami
l
y☐Mul
ti
fami
l
y

Doy
our
equi
reai
rpor
tpi
ck-
up? ☐Yes☐No Doyouneedshor
tter
m accommodat
ionupon ☐ Ye ☐ No
ar
ri
val
? s
What
typeof
accommodat
iondoy
our
equi
 re?

☐ Host
el Howmanyni
ght
sdoy
ouwantt
obook?
☐ Hot
el/
mot
el Howmanyni
ght
sdoy
ouwantt
obook?
☐Homest
ay Ami
nimum booki
ngper
iodof4weeksappl
i
es

Homestayandshor
t-
term accommodat
ionmustberequest
edatleast2weekspr
iort
oarri
val
.Yourof
ferl
ett
er
wil
li
ncl
udeachargefortheabover
equest
edserv
ices.Formor
einformat
ionpl
easecont
actLawsonColl
ege.

DISABILITY
Doyouhav eadi
sabil
it
y,i
mpair
mentorl
ong-
ter
mmedical
condi
ti
onwhichmay
aff
ect
your
studi
es? ☐Yes
☐No
Doy ourequiresupportfr
om LawsonCol
l
egeAust
ral
ia ☐Yes ☐No
Ihav
eat
tachedsuppor
ti
ngev
idencet
oout
li
nemyr
equi
rement
s.☐Yes ☐No

SECTI
ON7.STUDENTDECLARATI
ON Yes No
1.Idecl
arethattheinf
ormati
onsubmitt
edwiththi
sappl
i
cati
onistr
ueandcomplet
e.Ifur
ther
declarethatanyacademicresul
tssubmit
tedareacomplet
erecor
dofal
lresult
sIhav e
obtainedfr
om ever
yinst
it
uti
onIhaveatt
ended.
☐ ☐

2.
☐ ☐
I
acknowl
edget
hat
fai
l
uret
odi
sclosemy academi
crecor
dmay
resul
ti
ntheCol
l
eger
evoki
nganof
fe
rort
ermi
nati
ngmystudi
esatanystage.
3.Iauthori
set heCol legetoseekv eri
fi
cat
ionofmyacademi candpr of
essionalquali
fi
cati
ons,
andwor kexper i
ence.Iunder standthatt heColleger eser
vest her i
ghttoinform other ☐ ☐
terti
aryinsti
tutionsandr egulat
oryagenciesifanyoft hemat er
ialpresent
edtosuppor tmy
applicat
ionisf oundt obefalse.
4. Iunderst
andt hatattheti
meofenrolmentI
wil
lberequi
redtosupply
ori
ginal
sofall
documentsused
tosuppor tthisapplicat
ion. ☐ ☐

5.
I
acknowl
edget
hatt
heColl
egereser
vest
her
ight
toal
ter
any
cour
se,
subj
ect
,admi
ssi
onr
equi
reme ☐ ☐
ntorf
eewit
houtpri
ornot
ice.
6.
I
underst
andthatt
heper
sonali
nformati
onI
havepr
ovi
dedmay
berel
easedt
ogover
nmentagenci
e
sasrequi
redbylaw,Ifur
therunderst
andthati
tmaybedi
scl
osedtothi
rdpar
tiesf
orthe
☐ ☐
pur
poseofpr ogr
essi
ngmy appli
cat
ion.
7. I
acknowl
edget
hat
Ihav
ereadandunder
standt
hedescr
ipt
ionof
thepr
ogr
am/
sthat
Iamappl
yi
ng
f
or. ☐ ☐

8.
I
aut
hori
set
heColl
eget
oaccesst
heAust
rali
ani
mmi gr
ati
onVi
saEnti
tl
ementsVer
if
icat
ionOn ☐ ☐
l
i
ne(VEVO)syst
em atanyti
met oobt
aininf
ormati
ononmy vi
sastat
us.
9. I
declaret
hatI
amapplyi
ngt
obeagenuinetemporaryentrant
toAustral
i
aandasagenuinestudent
andthatIhavereadandunderst
oodcondit
ionsrelati
ngtot hese
requi
rementsht
tps:
//www.homeaff
air
s.gov
.au/t
rav /
stud/mor e/
genui
ne-t
empor ary-
entrant
☐ ☐

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ionFor
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 10.1Iam awareofthetuit
ionandli
vi
ngcostsofmyst
ayinAustral
i
aandhavethefinanci
al
capaci
tytomeetsuchcost sf
orthedur
ati
onofmycourse.Iwi
llmaket
imelypaymentsof ☐ ☐
anyfeesorassoci
atedcosts.
11.Idecl
aret
hatmysi
gnat
urei
str
ueandcor
rectandmat
chest
hesi
gnat
urei
nmypasspor
t.
☐ ☐

12.Iunder
standthatmyst
udentv
isar
equi
resmet
omai
ntai
nsat
isf
act
orycour
seat
tendance
andprogr
ess. ☐ ☐

13.Iunderst
andthatmyst udentvisarequir
esmet oremainwit
hmyproviderunt
ilIcompl
ete6
monthsofmypr i
ncipalcourse.Wher emyapplicat
ioncont
ainsmor
et hanonecourse,t
he
pr
inci
palcour
seisthehighestlevelofcour
se.
☐ ☐

14.Iunderst
andt
hatColl
egehasrulesr
egardi
ngcour
set
ransf
er,
andImaynotbeabl
eto
changemycourse/
swithoutpermi
ssi
on. ☐ ☐

15.Iunder
standt
hatImayi
ncural
atepay
mentf
eei
fIdonotpaymyf
eesbyt
heduedat
e/s.
☐ ☐

16.Mycoursesel
ect
ioncorr
espondswi
thmyacademi
cand/
orpr
ofessi
onal
backgr
oundand
myf
uturecar
eerpath. ☐ ☐

I(i
nser
tful
l
name): underst
andal
l
ther
equi
rement
sfort
hecour
sesandv
isaappl
i
cat
ionandconf
ir
mthatal
loft
hei
nformati
onpr
ovi
dedi
str
ue.

Appl
i
cantsi
gnat
ure: Dat
e:( )

SECTI
ON8.AGENTDECLARATI
ON Yes No
1.Theappl
i
canthasbeenassessedasaGenui
neTemporar
yEnt
rantandaGenui
neSt
udentas
defi
nedbytheAust
ral
i
anDepartmentofHomeAff
air
s(DHA). ☐ ☐

2.Theappli
canti
sgenui
nei nmakingt
hisappl
i
cat
ionandhasev
eryi
ntent
ionofcompl
eti
ngal
l ☐ ☐
coursesl
i
stedinthi
sappl
icati
on.

3.Everyeff
orthasbeenmadet
over
if
ytheaut
hent
ici
tyandv
ali
dit
yoft
hedocument
swhi
chf
orm
☐ ☐
partofthi
sappli
cati
on

4.Whereanappli
canthassubmit
tedanoff
shor
eEngl
i
shpl
acementt
est
,theAgencyguar
ant
ees ☐ ☐
thatt
hetesti
stheworkoftheappli
cant
.

5.Hast heappli
cantbeenprovi
dedi
nformationaboutf
eesandliv
ingcostsi
nAustral
i
aand
underst
andst hei
robli
gati
ontopayt
heirfees?Hastheappl
icantprov
idedevi
denceoffunds ☐ ☐
outl
inedintheappli
cati
onform?

6.Ihav
epr ov
idedt
heappl
i
cantwit
hi nf
ormat
ionr
egar
dingt
hel
ocat
ionofLawsonCol
l
ege,
cour
se
☐ ☐
i
nformati
onandstudy
ingi
nMelbourne.

AgencyName:

Agencyst
affmembername:

Post
alAddr
ess: Agent

LawsonCol
l
egeAust
ral
i
a
POBox7155
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oria,
3175Melbour
ne
Austr
ali
aPhone:+61397912211
Email
:lof
@lawsoncoll
ege.
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au

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Dat
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h: Appl
i
cant
’semai
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secondar
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