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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 />

@

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