ENGLISh LANGUAGE PROFICIENCyas all courses are taught in English, applicants will need to meet <strong>Curtin</strong> singapore’s English language requirements. if your education qualifications were notcompleted wholly or predominantly in English, please indicate what test/s you have taken (or intend taking) and attach certified* documentary evidence of results.gCE ‘O’ level iElTs TOEFlPTE Eald/ElaCs O<strong>the</strong>r (please specify)would you like to apply for a Navitas English language course? y NPlease note: having made this selection, you will receive a package from <strong>Curtin</strong> <strong>Singapore</strong> and Navitas English.EDUCATIONAL qUALIFICATIONSPlease provide details of all formal studies you have completed and those you are currently undertaking.you are required to supply an original or certified* copy of your academic award/s and transcript/s for all tertiary studies except those undertaken at <strong>Curtin</strong>university. academic records must contain an explanation of grading system descriptions.Name of qualifications(e.g. gCE ‘O’/’a’ level, hsC, degree)Institution/school/university(e.g. singapore Polytechnic)year enrolled(e.g. 2010)year completed (e.g.2012 or not completing)Date results expected(if applicable)would you like <strong>the</strong> above qualifications to be assessed for recognition of Prior learning (rPl)? y NEMPLOyMENT DETAILS (TO bE COmPlETEd iF aPPlyiNg FOr a POsTgraduaTE COursE whErE wOrk ExPEriENCE is aN ENTry rEquirEmENT).Note: submission of supplementary information to your postgraduate application varies across courses.Employer/company nameaddressPost/zip codeContact name Telephone +Position title and brief description of your dutiesEMERGENCy CONTACT DETAILSNamerelationship Telephone +MEDICAL/DISAbILITy NEEDSThe information below is used to assist <strong>the</strong> university in monitoring, supporting and improving services to students with medical/disability requirements.disclosing this information will not affect your admission to <strong>the</strong> university.do you have a disability, impairment or long-term medical condition which may affect your studies? y NPlease indicate <strong>the</strong> type/s of disabilityhearing vision learning medical mobility O<strong>the</strong>rif you have a disability, would you like to receive information on support services, equipment and facilities available that may assist you? y NFAMILy bURSARy DETAILS (PlEasE PrOvidE dETails OF ThE Family mEmbEr whO is CurrENTly sTudyiNg Or PrEviOusly sTudiEd aT CurTiN Or NaviTas.)Name student id location <strong>Curtin</strong> campus Navitas institutionAPPLICANT’S DECLARATION AND SIGNATUREi declare that i have read <strong>the</strong> instructions on this application form and that <strong>the</strong> information i have provided is complete and correct. i understand that <strong>the</strong> information collected on thisform is to enable <strong>Curtin</strong> singapore to assess my application, create a record on its student database, undertake statistical analysis, meet statutory reporting requirements and fur<strong>the</strong>rinform me about <strong>the</strong> course to which i am applying as well as <strong>the</strong> university’s o<strong>the</strong>r courses/events. The information will be accessed by university officers strictly for <strong>the</strong>se purposes anddisclosed to state and singapore government agencies where required by law. Pursuant to obligations to contractors (such as mail houses) engaged by <strong>the</strong> university to perform serviceson its behalf. where personal information is to be provided to contractors, <strong>the</strong> university will require that confidentiality agreements be first entered into.i accept that information supplied in this application may also be made available to a <strong>Curtin</strong> singapore overseas representative to provide assistance with my application.i understand that if i do not complete all <strong>the</strong> questions on this form, it may not be possible for <strong>the</strong> university to process my application. i authorise <strong>Curtin</strong> singapore to obtain fur<strong>the</strong>racademic information or official student records from any educational institution or recognised educational qualifications assessment body necessary and/or, where my work experienceis relevant, to verify my employment history for <strong>the</strong> purpose of making an informed decision about my application.i understand that <strong>Curtin</strong> singapore is not responsible if any educational body/institution does not supply qualification records, that <strong>the</strong> results of this search may be made available tome on request and an audit of this authority may also be undertaken. if i do not meet all <strong>the</strong> university’s entry requirements, i authorise <strong>the</strong> university to provide my full application to<strong>Curtin</strong> singapore approved pathway providers (e.g. <strong>Curtin</strong> College) for consideration for <strong>the</strong> preparatory program (foundation/diploma). i understand that successful completion of thisprogram will help qualify me for admission into specified courses of <strong>Curtin</strong>. i understand that i have <strong>the</strong> right to access and amend personal information that <strong>Curtin</strong> singapore holds aboutme, subject to legislation, by contacting <strong>Curtin</strong> singapore at info@curtin.edu.sg.i acknowledge that <strong>Curtin</strong> singapore reserves <strong>the</strong> right to vary or reverse any decision regarding admission made on <strong>the</strong> basis of incorrect, incomplete or fraudulent information.signatureLODGING yOUR APPLICATIONPlease submit your application to<strong>Curtin</strong> <strong>Singapore</strong> or a <strong>Curtin</strong> <strong>Singapore</strong>overseas representative<strong>Curtin</strong> singapore90 and 92 Jalan rajahsingapore 329162Tel: +65 6593 8000Fax: +65 6593 8001Email: admissions@curtin.edu.sgPRIVACy STATEMENTat <strong>Curtin</strong> singapore, <strong>the</strong> privacy of our students, staff and <strong>the</strong> people we deal with is very important to us.much of <strong>the</strong> information <strong>the</strong> university collects in order to provide <strong>the</strong> services that it does, is personal information.For details of how <strong>the</strong> university will use, disclose and protect your personal information please refer toglobal.curtin.edu.au/legal/privacy.cfm<strong>Curtin</strong> singapore collects, stores and uses personal information for <strong>the</strong> purposes of administering prospective, current andgraduate student admissions, enrolment and education. we may, for example, share your personal information with <strong>the</strong><strong>Curtin</strong> singapore marketing department, so that <strong>the</strong>y can contact you (including by electronic means) with informationabout products and services that may interest you. if you do not wish to receive marketing offers from <strong>Curtin</strong> singapore(by post, phone or o<strong>the</strong>r electronic means), please tell us by checking this box.*Certified means witnessed by an authorised <strong>Curtin</strong> representative, <strong>Curtin</strong> international staff member, a person of authorityat <strong>the</strong> issuing institution (e.g. registrar), Justice of <strong>the</strong> Peace, Commissioner for Oaths/declarations, or any notary public.dateCUSG_APPFORM_0313_AW
apply now37Toa PayohNS19Lor 6 Toa PayohExit 17PIEJln RajahEntranceJln TenteramJln DatohAh Hood RdJln RajahBalestier RdLor AmpasKim Keat RdWhampoa RdSt Michael'sTerminalJln Bahagia<strong>Curtin</strong><strong>Singapore</strong>Irrawaddy RdWhampoa DrExit 7BCTEWhampoa RiverThomson RdNovenaNS20Jln Tan Tock SengMandalay RdMoulmein RdExit 7ASerangoon RdBoon KengNE9notes
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