C10-042 PathwaysCQUCollege2011.indd - Study Brisbane
C10-042 PathwaysCQUCollege2011.indd - Study Brisbane
C10-042 PathwaysCQUCollege2011.indd - Study Brisbane
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APPLICATION FOR ADMISSION<br />
(Foundation Studies, Undergraduate and Postgraduate<br />
Coursework Programs)<br />
International Applicants Only<br />
Please write in BLOCK letters using a black pen.<br />
1. PERSONAL DETAILS<br />
Title Mr Mrs Ms Miss Other<br />
Family name<br />
Given names<br />
Date of birth (DD/MM/YY)<br />
Gender<br />
Male<br />
Female<br />
Have you been enrolled at CQUniversity previously? Yes No Student number (if known)<br />
What are your contact details in your home country?<br />
Home address<br />
Town/city<br />
Country<br />
Postcode/ZIP<br />
Telephone number<br />
Mobile<br />
What are your current contact details?<br />
Home address<br />
Town/city<br />
Country<br />
Postcode/ZIP<br />
Tear off and fax or mail to your chosen campus.<br />
Telephone number<br />
Agent Details. Place stamp below (if applicable)<br />
Counsellor’s name<br />
Email address<br />
Mobile<br />
What country are you in when completing this form?<br />
Where should we send notification of your application results? Home country Contact<br />
Agent<br />
2. APPLICANT’S PERSONAL EMAIL ADDRESS<br />
Email address<br />
@