| * required |
part 1: personal details |
| |
|
|
| School / location |
* |
|
| |
|
|
| First or given name |
* |
|
| Last or family name |
* |
|
| Gender |
* |
|
| Date of birth |
* |
|
| Country of nationality |
* |
|
| Country of birth/origin |
* |
|
| Passport number |
|
|
| Visa |
* |
Student
Visitor
Working Holiday
Other |
| Have you previously studied at GV? |
* |
Yes
No |
part 2: address & contact information |
| Email address |
* |
|
| Instant Messaging ID/Name |
|
|
| Instant Messaging Service/Provider |
|
|
| Home telephone number |
* |
(including country and area code) |
| Mobile/alternate telephone number |
|
(including country and area code) |
| Fax number |
|
(including country and area code) |
| Home address, line 1 |
* |
|
| Home address, line 2 |
|
|
| Home address, line 3 |
|
|
| City or Town |
* |
|
| State, Province |
|
|
| Postal or Zip Code |
|
|
| Country of residence |
* |
|
| If you are already living in Australia, please enter your full Australian
address |
|
|
| Phone number in Australia, if known |
|
|
| |
|
|
part 3: next of kin & emergency contact information |
| First or given name |
* |
|
| Last or family name |
* |
|
| Relationship (parent, friend, etc.) |
|
|
| Email address |
* |
|
| Home telephone number |
* |
(including country and area code) |
| Mobile/alternate telephone number |
|
(including country and area code) |
| Full address including country |
* |
|
part 4: english program |
| English program |
* |
|
| Start date (preferred) |
* |
|
| Number of weeks |
|
|
| ESL/English level |
* |
|
| Comments or questions about the English program |
|
|
part 5 (a): accommodation |
| Choice of accommodation |
* |
|
| Accommodation start date |
* |
(dd / mm / yyyy) |
| Number of weeks |
* |
|
| Do you smoke? |
* |
Yes
No |
| Do you have any allergies? |
* |
Yes
No |
| If yes please explain |
|
|
| Do you take any medications? |
* |
Yes
No |
| If yes please explain |
|
|
| Do you have any special dietary requirements? |
* |
Yes
No |
| If yes please explain |
|
|
| Do you have any particular hobby? |
* |
Yes
No |
| If yes please explain |
|
|
| Can you live with pets? |
* |
Yes
No |
| Can you live with young children? |
* |
Yes
No |
part 5 (b): care and supervision |
| All students under 18 years of age must have an adult carer in Australia. More information about this is available on the Australian
government immigration website. |
| Do you need us to arrange a carer? |
* |
Yes
No |
| If no, you MUST provide the details of your own Carer: |
| Carer's first name |
|
|
| Carer's last name |
|
|
| Carer's email address |
|
|
| Carer's home phone number |
|
|
| Carer's work or mobile phone |
|
|
| Relationship with student (friend, family member, etc.) |
|
|
part 6: airport transfers |
Arrivals |
|
|
| Do you need airport pickup? |
* |
Yes
No |
| If yes please indicate |
|
|
Departures |
|
|
| Do you need airport drop-off? |
* |
Yes
No |
| If yes please indicate |
|
|
part 7: payment & legal information |
Payment |
|
|
| How will you pay? |
* |
|
Conditions of Enrolment & Refund Policy |
|
Travel & Medical Insurance |
|
Other Information |
| How did you hear about GV? |
* |
|
| Please detail/explain |
|
|
| If you are registering through an authorized GV agent,
please name this agency |
|
|
| Add your comments or questions |
|
|
| |
|
|