国际留学生申请表格 International Student Application Form

• 请英文填写表格内容
Please fill in the form in English
• 该表格适用于所有网上递交院校申请表格，如学校需要额外表格，ACIC 客户经理会与您联系确认
This form is applicable for all applications submitted online, if extra forms are needed, your
admissions will confirm with you
• 该表格需要申请人本人签名，并和护照签名一致。不接受电子签名
This form needs to be signed by student and signature needs to be same as passport one.
Electronic signature may not be accepted
• 学生个人邮件地址需要真实有效，以避免学生无法正常收到学校重要信息
Student’s email address needs to be valid, to avoid delays to receive information from university

1. 学生个人基本信息 Personal details

姓 Family name: ................................ 名 Given names: ................................
曾用名 Previous name if any: ................ 学生目前所在国家 Country of current residence: ..................
出生日期 Date of birth: ................................... 性别 Gender: 男 Male ☐ 女 Female ☐
国籍 Citizenship: ............................................ 出生地点 Place of birth: .............................................
护照号码 Passport No.: .......................... 护照有效期至 Date of Expiry: .....................................
婚姻状况 Marital Status: 单身 Single☐ 其他 Others☐ ....................................

2. 学生联系方式 Applicant contact details

国内家庭住址 Applicant’s permanent address:
..................................................................................................................................................................
省 State: ................................... 邮编 Post/zip Code: ...................................
住宅电话 Home Phone: .......................................... 手机号码 Mobile: .................................................
澳洲住址 Applicant’s onshore address if any: .......................................................................................
学生电子邮件 Email Address:..................................................................................................................

3. 学生签证信息 Applicant Visa History details

是否持有澳洲PR Does student have Australian permanent residency................... 是 Y ☐ 否 N ☐

目前是否持有任何澳洲有效签证 Does student have any valid Australian visa........ 是 Y ☐ 否 N ☐
是否有过澳洲拒签史 Does student have Australian visa rejection history............... 是 Y ☐ 否 N ☐
是否有过其他国家拒签史 Does student have visa rejection history for other countries ………………
是Y☐否N☐
以上选项如果有选“是”,请提供具体信息 Please provide detailed information if answer is Y for any of
above: ...................................................................................................
4. 父母联系方式 Parent contact details
父亲信息 Father:
姓 Family name: ................................ 名 Given names: ................................
家庭住址 Home address: 同上 same as above ☐ 或 or
☐.......................................................................................................
手机号码 Mobile: .....................................电子邮件 Email Address: .......................................................
母亲信息 Mother:
姓 Family name: ................................ 名 Given names: ................................
家庭住址 Home address: 同上 same as above ☐ 或 or
☐ .......................................................................................................
手机号码 Mobile: .....................................电子邮件 Email Address: .......................................................
紧急联系人(18岁以下学生提供) Emergency Contact (under 18 students only)：
父亲信息同上 same as father’s details ☐ 母亲信息同上 same as mother’s details ☐
其他 others ☐ ......................................................................................................

5. 申请院校及课程 Program of study

• 请根据学生志愿的优先顺序填写学校及专业 Please put student’s preferences in orders

• 课程信息请填写完整准确，包括课程编号Course Code，专业方向，是否申请减免学分等
Please fill in as much information as possible including course code, major, and credit transfer

1) 申请院校 Institution Name: ................................................................................

开学日期 Intake Date: .............................................. (Semester/Year eg: S1 2022)
课程1 Program: ................................................................. 专业方向 major: ...........................................
课程编号 Course Code: ........................ 课程长度: Length ............... 校区 Campus: ............................
课程2 Program: ................................................................. 专业方向 major: ...........................................
课程编号 Course Code: ........................ 课程长度: Length ............... 校区 Campus: ............................

申请减免学分 Credit Transfer 是Y ☐ 否N ☐ 是否提供教学大纲 Course Syllabus 是Y ☐ 否N ☐

是否已经或曾经申请过该学校 Have you applied for this university before 是Y ☐ 否N ☐

如“是”,请提供详细内容: Please provide details if Y for above.................................................................

2) 申请院校 Institution Name: ................................................................................

开学日期 Intake Date: .............................................. (Semester/Year eg: S1 2022)
课程1 Program: ................................................................. 专业方向 major: ...........................................
课程编号 Course Code: ........................ 课程长度: Length ............... 校区 Campus: ............................
课程2 Program: ................................................................. 专业方向 major: ...........................................
课程编号 Course Code: ........................ 课程长度: Length ............... 校区 Campus: ............................

申请减免学分 Credit Transfer 是Y ☐ 否N ☐ 是否提供教学大纲 Course Syllabus 是Y ☐ 否N ☐

是否已经或曾经申请过该学校 Have you applied for this university before 是Y ☐ 否N ☐

如“是”,请提供详细内容: Please provide details if Y for above.................................................................
3) 申请院校 Institution Name: ................................................................................
开学日期 Intake Date: .............................................. (Semester/Year eg: S1 2022)
课程1 Program: ................................................................. 专业方向 major: ...........................................
课程编号 Course Code: ........................ 课程长度: Length ............... 校区 Campus: ............................
课程2 Program: ................................................................. 专业方向 major: ...........................................
课程编号 Course Code: ........................ 课程长度: Length ............... 校区 Campus: ............................

申请减免学分 Credit Transfer 是Y ☐ 否N ☐ 是否提供教学大纲 Course Syllabus 是Y ☐ 否N ☐

是否已经或曾经申请过该学校 Have you applied for this university before 是Y ☐ 否N ☐

如“是”,请提供详细内容: Please provide details if Y for above.................................................................

6. 学历以及工作经验 Academic Qualifications and Work Experience

• 请列出所有高中及以上教育学历背景 Please list all tertiary studies after high school

• 本科生请提供学籍登陆信息 Please provide logins for undergraduate studies

本科学籍系统链接 Login weblink: ..............................................................

登录名 Name: ............................................

密码 Password: ................................................
学历以及专业 就读/毕业院校名称 就读国家 入读时间-毕业时间 在校成绩
Level of Name of Institute Country Start Date- End date Academic Performance
Qualification and
name of Program 加权平均分 算数平均分
WAM Average
Eg: Bachelor of Eg: Fudan University Eg: China Eg: 09/2018–06/2022 Eg: 88 Eg: 89
Business
7. 工作经验 Work Experience
公司职位 公司名称 职务说明 入职时间-离职时间 公司地址、联系电话
Position Company Name Job Duties Start Date- End date Company Address
and
Contact Number

8. 英语程度 English Proficiency

是否有有有效的语言成绩 Do you have valid English test results? 是Y ☐ 否N ☐

如学生已有雅思、托福成绩，是否需要用该成绩配套语言课程 Would you like to package English
studies with current results 是Y ☐ 否N ☐

9. 信用卡持卡人授权 International Students Application Fee Authorization

• 如大学在线申请系统需要使用信用卡进行在线支付申请费，信用卡持卡人授权用本卡信息进行在线支付。
This fee slip must be completed and submitted along with student’s application if application fee is
applicable.
• 一旦申请在线递交成功，该费用将无法退还。Application fee is non-refundable once application is
lodged.
• 请确保本卡信息填写完整、准确、信用卡有足够余额并已开通国际网上支付功能。
Please ensure the information completed below is complete, accurate and it can be processed in
• Australia.
• 只接受Master or Visa 卡
Only Master and Visa cards are accepted

信用卡类型 Card Type: Mastercard or Visa

信用卡卡号 Card No: ...........................................................................
持卡人姓名 Name on Card: .................................................................
到期日期 (月/年) Expiry date (month/year): .........................................
卡背面三位安全码 3 Digit Security No.: ..............................................
持卡人签名Signature: ........................................................................
10. 申请人授权声明许可 Applicant Authority, Declaration & Agreement

I, .......................................... (Student Full Name) hereby grant written authority to ACIC as my agent
and to process my application and enrolment to the Universities in Australia on my behalf.
我本人..........................................授权ACIC 作为我的代理申请澳大利亚课程。

I declare and agree that: -

我声明并且同意：

1. All the Application Information and documents provided by me is true, up to date and complete. I
must promptly inform my agent of any change to the Application Information that may affect the
Application.
申请学校所提供的所有信息和材料是真实有效完整的。如有任何信息变化需要及时通知我的代理。
2. I provide my agent with permission to confirm my academic results as provided by me, from other
institutions directly or through third parties; I am willing to be cooperative in providing any
documents required by my agent regarding my application and enrolment.
我授权我的代理可与校方或第三方机构核实我所提供信息和材料的真实性，并会在申请入学过程中
积极配合代理提供要求的相关材料。
3. It is an offence to submit fraudulent documents or given false, incomplete or misleading
information for purpose of gaining admission to the university or visa approval. Where fraudulent
documents or misleading information are detected, it will be reported to relevant authorities. As a
consequence, any applications (School and Visa), offers, even enrolment may be cancelled, other
penalties may also apply.
我明白申请学校或签证时提供不真实、不完整或不准确的申请材料或信息是违法行为。一经发现，
该行为会上报给相关机构，会导致学校和签证申请被拒绝、录取资格被收回、甚至在读学生学籍也
可能会被取消，还有可能有其他相关处罚。

…………………………………………
申请人签名 Signed by Applicant
(如申请人小于18岁，需父母或监护人签名 Please have parent sign if applicant is under 18)

……………………………………....…
申请人名字 Name of Applicant

…………………………
日期 Date