Study Abroad or Incoming Exchange Program

CRICOS Provider Number 00025B

International Student Application for

Study Abroad or

Incoming Exchange Program

Applicant contact details2

Phone: ................................................................................................................. Mobile: ................................................................................................ Email: ............................................................................................................................

Applicant’s permanent address outside Australia:

Number and street:

.................................................................................................................................................................................................................................................................................................................................................

Suburb/town: ..................................................................................................State: ..............................................................................................................................................................................................................................................

Post/zip code: ................................................................................................Country: ........................................................................................................................................................................................................................................

Applicant’s mailing address (if different from above):

Number and street:

Proposed study and commencement date3

I wish to apply for: Study Abroad Incoming Exchange (Please attach exchange letter from home institution.)

Program commencement: Semester 1 (February) Semester 2 (July) Year: ....................................

How long will you study at UQ? 6 months 12 months

List the courses in which you wish to enrol:

See the UQ course catalogue online at www.uq.edu.au/study for course codes and titles.

Code Title Ofﬁce use only

............................................................................. ................................................................................................................................................................................... .....................................................................................................................

Instructions

• Answer all questions in sections 1-11.

• Do not complete this form if you are an

Australian/New Zealand citizen or an Australian

Permanent Resident.

• Print clearly using BLOCK LETTERS and tick

boxes where appropriate. Do not write in pencil.

We cannot consider your application if it is

incomplete or unreadable.

• Please return your completed application and documentation to:

The Manager, Study Abroad and Incoming Exchange Ofce

The University of Queensland

Level 2, JD Story Building

Brisbane, Queensland 4072, Australia

Web www.uq.edu.au/studyabroad

Email [email protected]

Phone +61 7 3365 7941 Fax +61 7 3365 1794

Home institution:..........................................................................

...........................................................................................................

Institution email contact: ...........................................................

...........................................................................................................

AGENT STAMP

Empl ID: .....................................................................

Appl ID: ......................................................................

Ofﬁce

use

only

English proﬁciency4

a) Is English your ﬁrst language? No Yes (If yes, move to section 6)

b) If your current level of English language proﬁciency does not meet UQ’s English language entry

requirements and all other entry requirements are met, would you like to receive a Package Offer, which

includes English Language tuition at UQ’s Institute of Continuing and TESOL Education (ICTE-UQ)?

c) Please tick the appropriate box to indicate any English test you have completed within the last two years:

TOEFL IELTS

Note:

• Test results are only valid for two years from the date of the test. Test results must still be valid the month your UQ degree program starts or they cannot be accepted.

• UQ will not accept institutional TOEFL tests, photocopies or certied copies of examinees’ TOEFL results. If you have not done so already, you must ask your TOEFL

testing centre to send your ofcial results to UQ. UQ’s TOEFL code is 0987.

• If you sat an IELTS test and you can provide an IELTS Test Report Form (TRF) number you do not need to provide an ofcial copy of your IELTS results to UQ.

My TRF number is: .............................................................

• If you sat an internet-based TOEFL test, please indicate your registration number and test date:

Registration number: ......................................................... Test date: ..............................................................

No Yes

If yes, please complete the ICTE-UQ application available

at www.icte.uq.edu.au and return with this application.

Personal details1

Family name: .............................................................................................................................................................................................................................

Given names: ............................................................................................................................................................................................................................

Date of birth: ...................................................................................................Gender: ......................................................................................................

Country of birth: ............................................................................................ Citizenship: ..............................................................................................

Country of current residence (country where

you have been living for the past three months)

: ........................................................................................................................................................

DD/MM/YYYY

UQ’s Privacy Policy is available at www.uq.edu.au/privacy11

Academic qualiﬁcations6

Please provide details of your current studies. You should either (i) request the Registrar of your home institution to send one ofcial transcript to the address listed under the

instructions on the front of this form, or (ii) attach to this form original or ofcially certied copies of your transcript. A certied copy of an original document is one which has been

certied as a true copy of the original document by an authorised representative of this University, a staff member of an Australian Education Centre, a university or college registrar,

a headmaster, a Justice of the Peace or notary public, or an examining authority. A key/guide to the grading system must also be included. Documents not in English must be

accompanied by ofﬁcial English language translations.

Program/award Institution name Country Attendance dates Completion/

(from-to) expected

completion date

.................................................................................................................... ................................................................................................................. ............................................................ .................................... ......................................

Overseas Student Health Cover8

It is a condition of a student visa that you maintain Overseas Student Health Cover (OSHC) for the duration of your studies in Australia.

On your behalf, The University of Queensland can organise program-length cover with OSHC Worldcare, its preferred provider of OSHC.

Yes, I would like UQ to arrange single rate OSHC for myself

No, I will make my own arrangements for the duration of my studies at UQ

I am a Swedish or Norwegian student covered by a government insurance scheme recognised by the Australian Government

Financial support7

Do/will you receive a student loan? (eg., US Stafford Loan): No Yes

If yes, please provide details:

Academic transcripts9

Please advise where you wish your UQ transcripts to be sent (in most cases this should be your home institution):

Contact name:

.................................................................................................................................................................... Contact phone number (required for delivery purposes): .............................................................

Contact address: ......................................................................................................................................................................................................................................................................................................................................................

69212 IntSAExch Aug12

Declaration and signature10

I agree:

• to The University of Queensland (the University)

communicating with me via electronic means;

• to permit the University to obtain my academic results

from other institutions directly or through Qualsearch;

• if any information provided by me is discovered to

be untrue or misleading in any respect, I consent to

the University collecting, storing and disclosing this

information to Universities Australia (UA) and UA

member institutions, the Australasian Conference of

Tertiary Admission Centres (ACTAC) and any other

relevant authority.

I understand that:

• two semesters of non-award study is the maximum permitted;

• submitted documents supporting this application become the property of the University and will not be returned to me;

• the University may vary or cancel any decision it makes if the information I have given is incorrect or incomplete;

• information is collected on this form and during my enrolment in order to meet UQ’s obligations under the ESOS Act and the

National Code 2007; to ensure student compliance with the conditions of their visas and their obligations under Australian

immigration laws generally. The authority to collect this information is contained in the Education Services for Overseas Students

Act 2000, the Education Services for Overseas Students Regulations 2001 and the National Code of Practice for Registration

Authorities and Providers of Education and Training to Overseas Students 2007. Information collected about me on this form

and during my enrolment can be provided, in certain circumstances, to the Australian Government and designated authorities

and, if relevant, the Tuition Assurance Scheme and the ESOS Assurance Fund Manager. In other instances information collected

on this form or during my enrolment can be disclosed without my consent where authorised or required by law.

I declare that the information I have given in this application is

correct and complete.

Applicant’s signature:

.....................................................................................................................................

Date: ....................................................

Signature of parent/legal custodian if student is under 18 years of age.

Parent’s/legal custodian’s signature:

....................................................................................................

Date: ....................................................

DD/MM/YYYYDD/MM/YYYY

Permission to release information (optional)12

I authorise the following person to access details regarding my application (compulsory for students under 18 years of age):

Family name:

........................................................................................................... Given name: ...................................................................................... Relationship to applicant: .....................................................................

Delegate’s signature: ......................................................................................................................................Date: ..........................................................

DD/MM/YYYY

Student disability arrangements5

For information, please visit www.uq.edu.au/student-services/Disability and contact UQ’s Disabilities Advisor: email [email protected] or phone +61 3365 1704