Education Online Enrolment Form

(** - required)

PERSONAL DETAILS

Title: Mr. Ms. Mrs.
**Family Name:
**Given Name:
Date of Birth: /day/month/year
Address:
State:
Country:
Post Code:
Telephone:
Fax:
**Email:
Occupation:
Type of Visa: Student Working Holiday
Visitor Business
Other
Expire Date: /day/month/year

COURSE DETAILS
Level of English:
Are you studying?: Yes No
If Yes,
Name of Institution:
Name of Course:
Finishing Date: /day/month/year
Course you wish to study:
other :
Institution you wish to study at:
How long?: Weeks
From when?: /day/month/year
Purpose of study:
other :

Education Background
Highest level completed:
Graduated: /month/year
Majors:
English Exam taken & Score(s): TOEFL:
TOEIC:
IELTS:
Other (name/score):

PAYMENT DETAILS
How do you want to pay?: Cheque/Bank draft/Money order
Telegraphic Transfer
Other :

ACCOMMODATION SERVICE

Do you need arrangement for accommodation and airport pick-up?
yes no
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