<strong>International</strong> UndergraduateaPPlication Form page 26. English Language Pr<strong>of</strong>iciencya. english is my first language: Yes Nob. I have undertaken studies in which the language <strong>of</strong> instruction was English:NoYes – please provide details and supply documentation:c. I have a valid* English Language Test (TOefl, IelTS, UeeC, CPE) result.YesNo (*expires 2 years after test date)Test Name:Test Date (dd/mm/yy):Test Score:d. I will beSitting for a testReceiving results from a testTest Centre will send results to <strong>UNSW</strong> Yes NoTest Name:Test Date (dd/mm/yy):*You MUST include original English Language Test results7. FundingHave you been awarded a scholarship or sponsorship?YesNoIf yes, provide name and evidence <strong>of</strong> scholarship/sponsor:9. Privacy Statement<strong>The</strong> information you provide on this application form is ‘personal information’as defined by the Privacy and Personal Information Act, 1998 (NSW) [theAct]. It is collected and held by <strong>UNSW</strong> in order to assess and follow up yourapplication for admission and for administrative and statistical purposes,or to send you information about <strong>UNSW</strong> activities relevant to your admissionand or enrolment. We may give your information to others inside and outsideNSW to facilitate this.You have the right <strong>of</strong> access to, and alteration <strong>of</strong>, theinformation concerning yourself in accordance with the Act and the <strong>UNSW</strong>Privacy Management Plan. <strong>UNSW</strong> will not disclose your personal informationwithout your consent and without due cause, except as authorised by law-set out in this Statement. You have the right to refuse this consent, but ifthe consent is not given your application may not be processed. By signingthis document you accept these conditions.10. DeclarationI declare that the information submitted in this application is correct andcomplete. I authorise the <strong>University</strong> to obtain and verify information fromany educational institution previously or currently attended by me, includingthrough the use <strong>of</strong> Qualsearch. If any information supplied by me is consideredto be untrue, incomplete or misleading in any respect, I understand the<strong>University</strong> may take such action as it believes necessary including thedisclosure <strong>of</strong> the information to any person or body the <strong>University</strong> considershas a legitimate interest in receiving it and I consent to such disclosure. Iunderstand the <strong>University</strong> reserves the right to vary or reverse any decisionmade on the basis <strong>of</strong> untrue, incomplete or misleading information.SignatureDate (dd/mm/yy):8. Check LiST(Your application cannot be considered unlessAll essential documents are attached.)I have included with this application form:<strong>The</strong> application fee (non-refundable) <strong>of</strong> A$100 payable by bank draft/bank cheque in Australian dollars made out to <strong>The</strong> <strong>University</strong> <strong>of</strong> <strong>New</strong> <strong>South</strong>Wales or complete the credit card authorisation for payment sectionbelow. Payable per application.Original or certified copies <strong>of</strong> secondary and previous tertiary studies(awards gained, marks and grades).If not in English, <strong>of</strong>ficial translations in English plus copies <strong>of</strong> the originallanguage document will be required. Self-translated documents are notaccepted and are considered fraudulent.English Language pr<strong>of</strong>iciency test result (must be an original copy).IelTS required for package <strong>of</strong>fer.Video, audio tape or portfolio if required.Copies <strong>of</strong> documents can be certified by:Public Notary, staff <strong>of</strong> Australian diplomatic missions, Justice <strong>of</strong> the Peacewith registration number, administration <strong>of</strong> institution which issued thedocument, <strong>of</strong>ficial representatives <strong>of</strong> <strong>UNSW</strong>, <strong>UNSW</strong> <strong>of</strong>fshore <strong>of</strong>fice staff.(NOTE: Unsigned Applications will NOT be processed)If you are under 18 years <strong>of</strong> age your parent/legal guardian must sign thisform.Send your completed Application and Application Fee to:Postal address:Direct Admissions Office<strong>UNSW</strong> Sydney NSW 2052 AustraliaFax +61 2 9662 1049Street Address:Direct Admissions Office<strong>The</strong> <strong>University</strong> <strong>of</strong> <strong>New</strong> <strong>South</strong> WalesLower Ground Floor, Chancellery BuildingGate 8 or 9, High Street, Kensington, NSW, 2052 AustraliaApplication Deadlines for All FacultiesSemester 1 > 31 October 2010Semester 2 > 30 April 2011ORwhen intake quotas have been reached, whichever is the earlier. Lateapplications may be considered where quotas have not been reached.However, the <strong>University</strong> does not guarantee applications can be processed intime for the requested start date. MBBS applicants should apply as early aspossible.Application Fee PaymentI wish to pay the <strong>UNSW</strong> Application Fee <strong>of</strong> A$100 by credit card:Mastercard VisaCARD No.Expiry Date / (month/year)Cardholder’s NameSignatureDate (dd/mm/yy):
<strong>UNSW</strong> Institute <strong>of</strong> LanguagesApplication FormPlease fill out this application form, selecting the course you wish to apply for and fax to: 61 2 9662 2651(see additional correspondence details over page). <strong>UNSW</strong> Institute <strong>of</strong> Languages will assess theinformation you supply and will then make you a course <strong>of</strong>fer based on this information.1. Personal Details (please print clearly)Family Name (as in passport)Given NamesOther names (your English name, if any)Female Male Birthdated d / m m / y yWill you be under 18 years <strong>of</strong> age on arrival?Yes No Please note: if you are under 18 years <strong>of</strong> age oncommencement <strong>of</strong> study, certain visa regulations apply.Country <strong>of</strong> BirthNationality (Citizenship)Passport No.2. Citizenship (please tick relevant box)Are you a citizen or permanent/temporary resident<strong>of</strong> Australia? Yes No* What type <strong>of</strong> visa will you be applying for?Student Student Dependant Tourist Working Holiday If you ticked a box with an asterisk (*), you will need OverseasStudent Health Cover (OSHC). This can be arranged by <strong>UNSW</strong>Institute <strong>of</strong> Languages (see Overseas Student Health Coversection). If you have already paid this, please quote :OSHC no.Expiry Date3. Home/Postal AddressAddress in Home Country (compulsory)CityStatePostcodeCountryTelFaxEmailAddress in Australia (if available)CityPostcodeMobileEmailTelFaxState4. English Language ProgramsCRICOS Code 067186JWhich course would you like to apply for?Placement in an English language course is subject to a placementtest on arrival or results <strong>of</strong> an IELTS <strong>of</strong> TOEFL test.English for Academic Purposes (EAP) Introduction to EAP (IEAP) AE Level 1 – 3 <strong>University</strong> English Entry Course (UEEC)+ Pre-Foundation English Year (PFY)+ Tertiary Orientation Program (TOP) IELTS Test Preparation Course (ITPC)+10-week courseGeneral Pr<strong>of</strong>iciency English (GPE) General Pr<strong>of</strong>iciency English (beginner to advanced) GPE Cambridge Exam PreparationPr<strong>of</strong>essional English English for Business Communication (intermed & adv) English for Medical Pr<strong>of</strong>essionals English for LawWhich term and date do you want to start yourEnglish course?How many weeks do you intend to study English?Number <strong>of</strong> weeks (in 5 week blocks)Have you been granted a scholarship?Yes No Scholarship Name or Sponsor’s Name5. English Language Test ScoresIf you have taken an IELTS or TOEFL test, please givedetails and attach a copy <strong>of</strong> the test result.IELTS Score (Overall)IELTS Writing ScoreCambridge ScoreTOEFL ScoreIBT/AP/CB Score