Application for Incoming FREEMOVER

Students

Bewerbungsnummer FRE:df

PERSONAL INFORMATION

Identity

Family name (as listed in your passport - no special Paudyal

characters)

First name (as listed in your passport - no special Prasiddha

characters)

Gender Male

Date of birth 11/12/2002

Country of birth Nepal

Place of birth (city, town, village, not the country of birth) Kathamandu

Nationality Australia

Nationality 2

Contact address

Country Australia

C/o

Street and number 29 Santiago Crescent

Street and number 2

Postcode 4300

City Spring Mountain

Phone number 0405848065

Email ppaud5082@gmail.com

Is the address above your home address? Yes

Identity document

Type Passport

Number PA7427317

Issued by Australian Government

Issued on 13/07/2018

Date of expiry 13/07/2023

School leaving certificate of the home country

School leaving certificate (e.g. High-School graduation High School Certificate

certificate)

Date of school leaving certificate 11/12/2019

School leaving grade Grade 12

Photo
 Passport photo file_63bf98ec7361e-passport.jpg

EMERGENCY CONTACTS

Contact

Family name Dev Raj

First name Paudyal

Relationship Father

Email paudyal@usq.edu.au

Phone number 0405848052

EDUCATIONAL BACKGROUND AND REQUESTED STAY AT THE OVGU

Information about your mobility

Country Australia

University University Of Southern Queensland

Faculty/Field of study Bachelor in Exercise Sceince

Degree/Qualification pursued (e.g. MSc in Biology) Bachelor in Sports and Exercise

Current level Undergraduate / Bachelor

Number of higher education study years prior to study 1

abroad

Begin of your study at your home university 01/2022

Language of instruction at your home university English

Programme Freemover

Faculty Faculty of Humanities, Social Sciences and Education

Study programme Bachelor (Guest) - Sports Science

Level Undergraduate / Bachelor

Academic year 2022/23

Start semester Summer semester 2023

Duration in semester 1

Planned date of arrival 15/01/2023

Planned date of departure 15/01/2024

LANGUAGE SKILLS

Mother tongue English

Mother tongue 2 Nepali

English language skills

 Language level C2

Language certificate High School Certificate

Score N/A

Date 11/12/2019

German language skills

Language level A1

Language certificate A1 Certificate

Score

Date 26/09/2022

FURTHER INFORMATION

Special needs

Do you have a disability, impairment or long-term medical No

condition which may affect your studies ?

RELEVANT DOCUMENTS TO BE UPLOADED

Photocopy of identity document file_63bf9bc947858-passport.pdf

Certificate of Bachelor/ Master Degree (if applicable) file_63bf9f1c5a435-usq_tsrpt.pdf

Transcript of Records file_63bf9e91890da-jpg2pdf.pdf

Language certificate file_63bf9ed735308-pdl_visumsanm_v2011_en.pdf

DECLARATION OF CONSENT

I certify that the information given in this application and Yes

the documents provided are correct and complete to the
best of my knowledge and belief. I understand that any
discrepancies in these details may result in my enrolment
being cancelled.

I have taken notice that the information on this form will be Yes
stored electronically and used by the international office in
accordance with the provisions of the Data Protection Act.

I agree that my name and email address can be forwarded Yes

to students for the purposes of promoting the exchange
programme.

I hereby confirm that I will comply with the laws of my host Yes
country and with the rules and regulations of the hosting
institution.