STUDENT DETAILS

Family Name* Given Name(s)*

Gender* MaleFemale
Date of Birth*
Nationality*
Country of Birth*

Language Spoken* Current Address*

Suburb/Town/City*
State*
Postcode/Zipcode*
Country*

Telephone/Mobile number* Email*

VISA

Passport Number
Which visa type do you plan to study under at SELC Australia?* StudentWorking HolidayTouristOther

Please specify

Which country will you lodge your visa application in?*

AGENCY DETAILS

Are you applying through an agency?* NoYes

Agency
Counsellor's Name*
Counsellor's Email*
Counsellor's Phone number
FURTHER EDUCATION

Do you wish to study in Australia after completing your English Course? NoYes

Institution Name
Start Date

Course Name

OVERSEAS STUDENT HEALTH COVER (OHSC)

Do you want SELC to arrange your OSHC? (student visa only) NoYes

OSHC Cover Type SingleCoupleFamily (Couple & Family Cover: Please attach passport copies of all partners and family members)
ACCOMMODATION

Do you want SELC to arrange your Accommodation? NoYes

Number of weeks
Check in date
Check out date

Homestay check-in must be on the Saturday or Sunday immediately before the course begins.
Type of Accommodation:
1. Homestay (2 weeks minimum stay) Half Board (Breakfast & Dinner)Room & Facilities (No meals) SingleTwin (with travelling companion) Do you smoke? NoYes, I will only smoke outside Do you have any allergies? NoYes Can you describe?
2. SELC Bondi Lodge (4 weeks minimum stay) Single (with bath)Single (share bath)Twin/Double (with bath)Twin/Double (shared bath)

ARRIVAL DETAILS

Do you want SELC to arrange your Airport Transfer? NoYes

One wayReturn
Flight Number
Arrival date
Arrival Time

NB. Changes in arrival details must be advised to SEC 72 hours in advance. If delayed in transit please contact our emergency representative as stated on your accommodation booking confirmation letter.

COURSE BREAKS

Do you require break during the course? (must be pre-arranged at the time of enrolment) NoYes

Number of weeks
From
To

Do you require a second break during the course? NoYes

Number of weeks
From
To

What is your English Level at the moment?* BeginnerElementaryPre-intermediateIntermediateUpper IntermediateAdvanced

SELC ENGLISH COURSE OPTIONS
COURSE BONDI START DATE #WEEKS
General Intensive English (Full-time)
| CRICOS 030264E
DaytimeEvening
General Intensive English (Part-time)
| CRICOS 030264E
Daytime
IELTS Preparation Daytime: Academic
| CRICOS 068858K Evening: General
DaytimeEvening
Cambridge Test Preparation FCE
| CRICOS 030269M
DaytimeEvening
Cambridge Test Preparation CAE
| CRICOS 030264E
Daytime
Cambridge Test Preparation CPE
| CRICOS 030264E
Daytime
English for Customer Service Communication (+ Barista)
| CRICOS 053857A
DaytimeEvening
My SELC Bondi Experience Package
| CRICOS 030264E
DaytimeEvening
REFERRAL

How did you hear about SELC?*

ENTRY REQUIREMENTS CHECKLIST

All Applicants (Evidence of the following must be provided)
Passport

DECLARATION
I confirm that the information I have provided is correct and that I have read, understood and agreed to abide by the SELC Australia Conditions of Enrolment. I authorise the SELC Australia Pty Ltd to verify any facts and hereby consent to the information being provided to a third party for further verification. I understand that if any information is found to be false or misleading my enrolment may be cancelled. I accept, will comply with policies and rules of SELC Australia Pty Ltd. It is my responsibly to familiarise myself with the latest version of the Student Handbook and policies and procedures, which can be found on www.selceducation.com. *

SUPPORTING DOCUMENTS
Please upload a copy of your supporting documents (Passport, English Certificate, Transcript, etc). If you don't have it now you can do this later.