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curtin english application form 2013/2014
Is your application through a CE/Curtin agent? Y N
Agent’s name:...................................................................................................
Agent contact: .................................................................................................
Email address: .................................................................................................
Section one—personal details
Student number (if any)
Title (Dr, Mr, Mrs, etc.) Male Female Date of birth
Family name
Nationality
Given name/s
Passport number
Home address
City
Telephone:
Country
Email
Aust. address (if known)
Course dates and fees 2014
City
Telephone
Emergency contact
Telephone
Section two—visa information
What type of visa will you apply for? Tourist visa Working holiday visa Student visa Other visa
General English, English for Academic Purposes (EAP) and
General Professional English (GPE)
Course dates
Course fees
Intake Orientation dates Course dates Weeks Fees
Module 1 3 Jan 6 Jan – 7 Feb 5 $2,075
Module 2 7 Feb 10 Feb – 14 Mar 10 $4,150
Module 3 14 Mar 17 Mar - 18 Apr 15 $6,225
2 weeks break 20 $8,300
Module 4 2 May 5 May – 6 Jun 30 $12,450
Module 5 6 Jun 9 Jun – 11 Jul 40 $16,600
2 weeks break 50 $20,750
Module 6 25 Jul 28 Jul – 29 Aug
Module 7 29 Aug 1 Sept – 3 Oct Weekly $415
1 week break
ELICOS fee
Module 8 10 Oct 13 Oct – 14 Nov
Module 9 14 Nov 17 Nov – 19 Dec
ELB 17 weeks
Course dates
Course fees
Intake Orientation dates Course dates Semester Fees
Semester 1 26 Feb 3 Mar – 27 Jun Total $8,500
Semester 2 16 Jul 21 Jul – 14 Nov
Summer
semester
15 Oct 20 Oct – 27 Feb (2015)
ELB 10 weeks
Course dates
Course fees
Intake Orientation dates Course dates Course Fees
Semester 1 16 Apr 21 Apr – 27 Jun Total $5,200
Semester 2 3 Sep 8 Sept – 14 Nov
Summer
semester
3 Dec 8 Dec – 27 Feb
Administration Fees
Enrolment fee $230
*inclusive of GST
Section three—course enrolment
Course/s I would like to enrol in:
Commencement date
General English 5 wks 10 wks 15 wks 20wks 25 wks 30 wks 35 wks 40 wks 45 wks 50 wks
General Professional English 5 wks 10 wks (Please note there are minimum entry requirements for this course)
EAP 5 wks 10 wks 15 wks 20 wks 25 wks 30 wks 35 wks 40 wks 45 wks 50 wks
ELB Semester 1 Semester 2 Summer
Note: your application will be assessed as to which ELB you are qualified to enter.
Section four—level of English (complete where applicable and provide certified evidence)
Do you have English test results? Yes No if yes, please provide the following details:
IELTS score: Date: TOEFL score: Date: Other (Test name): Score: Date:
*Important Note: If you have not taken any of these tests, please contact Curtin English for a Password Test.
Section five—further study
After completing your course at Curtin English, are you planning further study at Curtin University? Y N If yes, please complete below:
Start date
Course
Have you submitted an application to Curtin’s International Office for your University course? Y N
Section six—arrival in Australia and accommodation
Do you require pickup from the airport in Perth? Y N If yes, please complete Section 6.
Do you require CE to organise your accommodation? Y N If yes, please complete Section 7.
Section seven—airport pickup
Flight number Arrival date Arrival time
Section eight—accommodation and airport pickup
If required, which accommodation would you like? Homestay (with meals) Homestay (self catering) University residence
Note: fees are correct at time of print, but subject to change. Contact Curtin English for the latest fee information.
22
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Accommodation start date
Short-term accomodation Share house House rental
Number of weeks