INTERNATIONAL STUDENT APPLICATION FORM

- INSTRUCTIONS TO FOLLOW:

1. Form must be filled in BLOCK letters in English, with a BLUE or BLACK ink.
2. Please complete all sections.
3. Please write N/A (not applicable) if a section does not apply to you.
4. This is a fillable PDF form. Please do not convert to a word document to complete the form.

SECTION 1
- PERSONAL DETAILS

Title (Mr/Ms/other) Ms First name

Soneya

Surname Majumder
02/01/1983
Date of birth_________________________________________ Gender Male Female Indeterminate

Bangladeshi Single
Nationality Marital status

+8801926662587 +8801818674549
Mobile phone Home phone
majumder.soneya@gmail.com soneyaaa@yahoo.com
Primary Email Secondary Email

Are you currently studying in Australia? Yes No

If yes, name of institution Course

Have you studied at MIT before? Yes No If yes, STUDENT ID number

Are you currently employed? Yes No

- RESIDENTIAL ADDRESS (PLEASE WRITE THE ADDRESS ON YOUR PASSPORT)

H#140; Nogor Bari, Dakhshin khan

Address
Suburb
Dhaka Postcode 1230

Country
Bangladesh

- POSTAL ADDRESS (IF SAME AS ABOVE - WRITE ‘SAME AS ABOVE’)

Address same
same same
Suburb Postcode

Country same

- CAMPUS ADDRESS (IF YOU ARE IN AUSTRALIA - PLEASE WRITE YOUR CURRENT ADDRESS OR ELSE LEAVE BLANK)

Address
Suburb Postcode

Country

- STUDENTS WITH SPECIAL NEEDS

Do you have any medical conditions, disabilities, mental health or special needs that could impact upon your studies at MIT? Yes No
(Information provided is collected and held in accordance with MIT’s privacy policy statement available at www.mit.edu.au/privacy)
If yes, MIT will require further information from a relevant health professional outlining the impact it will have on your intended course of study.

Please list your condition(s):

Please list any special requirements that should be taken:

Do you have a management plan already in place? Yes No

If yes, please provide MIT with a copy of your management plan.
List any details that should be made available to paramedics / first-aid person?

Document Owner: Admissions & Marketing Current Version: 11 January 2023 Review Date: December 2023
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INTERNATIONAL STUDENT APPLICATION FORM

- OTHER INFORMATION
How did you first learn about MIT? You may tick more than one box.

Google Social Media Exhibition / Seminar Radio Other - Please state

Friend / Relative Agent - Please state the name of the agent and the branch

- AIRPORT PICKUP & HOMESTAY ARRANGEMENTS

Do you require MIT to arrange airport pick up? Yes No Do you require MIT to arrange homestay? Yes No
(Refer to Service Fees & Charges under www.mit.edu.au/study-with-us/tuition-fees) (Refer to Service Fees & Charges under www.mit.edu.au/study-with-us/tuition-fees)

SECTION 2
- COURSE PREFERENCE

Bachelor of Business - Accounting Major Master of Business Analytics Master of Networking

Bachelor of Business - Management Major Bachelor of Networking Master of Networking

(Cyber Security Major)

Bachelor of Business - Marketing Major Bachelor of Networking Bachelor of Engineering Technology

(Cyber Security Major) (Telecommunications - Only in Melbourne)

Bachelor of Business - Digital Marketing Major Bachelor of Networking Master of Engineering

(Software Engineering Major) (Telecommunications - Only in Melbourne)

Master of Professional Accounting Bachelor of Data Analytics Master of Data Analytics

Graduate Diploma of Accounting Graduate Diploma of Networking Master of Data Analytics

(Software Engineering Major)

Master of Business Research Master of ICT Research

- CAMPUS LOCATION & INTAKE (PLEASE SPECIFY)

Melbourne campus Sydney campus

When do you wish to commence your studies?

Trimester 1 (March Intake) Trimester 2 (July Intake) Trimester 3 (November Intake)

Term 4 (May Intake) Term 5 (September Intake)

- ENGLISH LANGUAGE PROFICIENCY

Do you have English test results? Yes No

If yes, please provide details below and attach certified evidence to this application:

IELTS Score 6 TOEFL Score PTE Score Other Date:

Bands Test name:

L R W S L R W S L R W S ___________________________
Score:
6 6 6 6

If no, please indicate your current level of English:

Beginner Elementary Pre-intermediate Upper intermediate Advanced

Please indicate which English course you want to apply for:

General English (GE) English for Academic Preparation (EAP)

Number of weeks: 5 10 15 20 25 30 Commencement date: __________________________________

What do you plan to do after you finish your English course at MIT?
MIT Undergraduate course MIT Postgraduate course Other:

Document Owner: Admissions & Marketing Current Version: 11 January 2023 Review Date: December 2023
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INTERNATIONAL STUDENT APPLICATION FORM

SECTION 3
EDUCATION AND OTHER DETAILS

- SECONDARY SCHOOL STUDIES

Month/Year of
Title of course Institution name
commencement Month/Year of completion
(e.g. A-level) and country
(e.g. January 2014)

Secondary School Certificate Dakhin Khan Adrasha Girl’s High

January 1996 April 1998
School Dhaka, Bangladesh
(S.S.C)

Higher Secondary Certificate Adamjee Cantonment College

September 1998 April 2000
Dhaka, Bangladesh
(H.S.C)

- TERTIARY OR POST- SECONDARY STUDIES

Month/Year of
Month/Year of Title of course Institution name
commencement
completion (e.g. Bachelor of Business) and country
(e.g. January 2014)

Govt. Titumir College, Dhaka

1. January 2002 January 2007 Bachelor of Science
(National University), Bangladesh

Eden Mahila College, Dhaka

January 2008 October 2009 Master of Science
2.
(National University), Bangladesh

3.

- RECOGNITION OF PRIOR LEARNING

Are you applying for Advanced Standing or Credit Transfer? Yes No

(If yes you must attach unit descriptions/ subject syallabus as per your transcripts and MIT Credit Transfer Form at the time of this application.).

- WORK EXPERIENCE (IF ANY)

Name of company Role Period employed

Educator Study Abroad HR & Admin December 2023 to continuing

The Bright Sun High School Vice Principal May 2022 to November 2023

Apple Tree International School Administrative Officer July 2017 to February 2022

Genex Infosys Ltd Executive

- APPLICANT VISA HISTORY

Country visa applied Category of visa Date of application Outcome of visa

USA Student Visa (F1) November 15, 2023 Refused

- FUNDING SOURCE

Who will sponsor your further studies in Australia including tuition fees and accommodation?
Please tick appropriately (You may tick more than one):

Self Parents Spouse Siblings Bank loan Others:

Document Owner: Admissions & Marketing Current Version: 11 January 2023 Review Date: December 2023
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INTERNATIONAL STUDENT APPLICATION FORM

SECTION 4
- DECLARATION AND APPLICATION CHECKLIST

Ensure certified copies of the following documents are attached at the time of submission:

Academic results and certificates Proof of English Proficiency

Passport bio-data page Credit transfer form and unit descriptions / subject syllabus (if applicable)

Visa copy (for onshore students) Proof of work experience (if applicable)

Statement of purpose including gaps in studies (if applicable) Documents for students with Special needs (if applicable)

- DECLARATION AGREEMENT

1. I declare that the information submitted with this application is complete and true. I acknowledge that failure to disclose my academic records may result in the Institute withdrawing an
offer or terminating my studies at any stage.

2. I authorise the Institute to verify my academic and professional qualifications, and work experience.

3. I understand that at the time of enrolment I will be required to supply originals of all documents provided at the time of this application.

4. I have read and understood MIT’s Privacy Policy located at http://www.mit.edu.au/privacy and authorise MIT to collect, use and disclose my personal information as permitted or required
by law and in accordance with the MIT Privacy Policy. In particular, I understand that the personal information that I have provided may be disclosed to Commonwealth and State
agencies, and designated authorities as required under the Education Services for Overseas Students (ESOS) Act 2000 and the National Code of Practice for Registration Authorities and
Providers of Education and Training to Overseas Students 2007 in certain circumstances, including changes to my enrolment, and any breach of a prescribed student visa condition.

5. I confirm that I have received and read a copy of MIT’s current prospectus and information available on www.mit.edu.au and fully understand the requirements of the course.

6. I have read, understood and consent to the Terms and Conditions of Enrolment and the Fee Payment and Refund Procedures at Melbourne Institute of Technology.

7. Australian Law states that applicants under 18 years of age must have signed consent from a Guardian or Parent. Please ensure all applicants for students under the age of 18 are
countersigned by Guardian or Parent.

8. I understand that the Institute reserves the right to alter any course, unit, entry requirements or fee without prior notice.

9. I authorise the Institute to access the Australian Immigration Visa Entitlements Verification Online (VEVO) system at any time to obtain information on my visa status.

10. I declare that I am a genuine temporary entrant and genuine student and that I have read and understood conditions relating to these requirements available at www.homeaffairs.gov.au

11. I am aware of the tuition and living cost of my stay in Australia and have the financial capacity to meet such costs for the duration of my program.

12. I declare that my signature is true and correct, and matches the signature in my passport.

13. I understand that MIT makes no guarantee that I will be offered a place on my selected course or that places will be available for any particular course, and I acknowledge that MIT may
impose limitations or conditions on enrolment in any course.

The above mentioned information is true to the best of my knowledge and belief.

Signature of applicant
(Must match signature on passport)

Signature of guardian
(If applicant is under 18 years of age at time of application)

31/03/2024
Date: _____________________________

- TO BE COMPLETED BY AGENT (NOT APPLICABLE FOR DIRECT APPLICANT)

The above mentioned information is verified and true to the best of my knowledge and belief.

Branch Manager or Authorised Officer:

Name

Signature

Branch Address

Office stamp: Send application to:

Admissions & Marketing Department
Melbourne Institute of Technology
Level M, 288 La Trobe Street T +61 3 8600 6700 4

Melbourne,VIC 3000, Australia E enquiries@mit.edu.au

Document Owner: Admissions & Marketing Current Version: 11 January 2023 Review Date: December 2023
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