program Please select: on-campus How to Apply: Please read the information contained in the program brochure before completing this form. In order to be considered for admission to this program you will need to meet the Entry Requirements as outlined in the course brochure and EIT's Admissions Policy. Applications should be submitted at least one calendar month prior to the start of the program. Late applications may only be accepted if the application can be processed prior to the start of the program. Please print clearly. Attach additional pages if insufficient space. If you are a permanent resident or citizen of Australia or New Zealand you cannot apply using this form. Please contact perthcampus@eit.edu.au for the relevant application form. To apply via email Complete this form and email it to perthcampus@eit.edu.au For all office locations and contact details, please visit our website: www.eit.edu.au 1. Personal Details i. Your full name Title (Ms/Mrs/Mr/Other): family (Last) Name: Given (First) Names: Preferred Name: ii. your email address: iii. Daytime Contact Phone Number: After Hours Contact Phone Number: iv. your date of birth (dd/mm/yyyy): v. gender (select one): Male Female vi. What is the street address of your usual residence? Building/Property Name: flat/unit Number & Street Number: Street Name: PO Box or Roadside Delivery Box: Suburb, Locality or Town: State/Territory/Province: Zip/Postcode: Country: vii. What is your postal address? Building/Property Name: (If your Postal Address is the same as your Street Address, please write "as above".) Flat/Unit Number & Street Number: Street Name: PO Box or Roadside Delivery Box: Suburb, Locality or Town: State/Territory/Province: Zip/Postcode: Country: viii. Photo ID Requirements A requirement of studying with EIT is the provision of evidence of your current name. Evidence of current name must include photo ID and includes a copy of a current passport. If you do not have a current passport, then include a copy of a current drivers licence or other official licence or photo ID card. I confirm I have included evidence of my current name with this application form: YES ix. Professional Memberships Please list any professional associations of which you are currently a member. This may include IEEE, Engineers Australia, ISA, IMC UK, ECSA or any other professional associations. State membership number if applicable. name of Professional association membership id # 1 V0005 CRICOS IPC 03567C Higher Education ID PRV14008 ACN 135 762 426
2. Language and Cultural Diversity i. In which country were you born? ii. Are you of Australian Aboriginal or Torres Strait Islander Origin? (For persons of both Aboriginal and Torres Strait Islander origin, select both Yes boxes) NO Yes, Aboriginal Yes, Torres Strait Islander iii. What is your first language? If English is not your first language, please provide details of your highest level of completed studies within the last 3 years where the sole language of instruction used was English. Please state qualification and institution: Applicants whose first language is not English may also be asked to provide evidence of English proficiency. Please see our website (proficiency in the English language: www.eit.edu.au/policies/eit_english_proficiency.pdf) for more details. 3. Disability i. Do you consider yourself to have a disability, impairment or long-term condition? (Please select one) yes Go to question 3.ii no Go to question 4 ii. please indicate the areas of disability, impairment or long-term condition: (Please select one) Hearing/Deaf Physical Intellectual Learning Mental Illness Acquired Brain Impairment Vision Medical Condition Other If you have selected 'Other', please outline: 4. Academic Achievements and/or Programs Completed i. PLEASE LIST THOSE QUALIFICATIONS AND/OR PROGRAMS THAT YOU BELIEVE ARE RELEVANT TO THE PROPOSED PROGRAM. Attach certified copies of the transcripts for relevant qualifications attained to date* Institution Name and Location Qualification or program title Date started Date finished duration Grade * Certified copies, not originals, should be provided. The transcript(s) must show all programs attempted including grades and an official statement to confirm that all requirements for the degree or diploma have been satisfied. If a transcript is not yet available please attach a certified written record which includes all grades. Documents can be certified by a Manager of a Bank, Lawyer, Sergeant or higher rank in the Police force, Postal Manager, School Principal, Hospital Registrar, Certified Accountant. Those certifying documents should write: This is a true copy of the original document signed by me, followed by their signature then printed name, address, contact telephone number, occupation and date. 2 V0005 CRICOS IPC 03567C Higher Education ID PRV14008 ACN 135 762 426
ii. mathematical ability Please outline the highest level of maths study you have achieved and where possible include evidence as an attachment to your application: iii. Physics ability Please outline the highest level of physics study you have achieved and where possible include evidence as an attachment to your application: iv. Research Skills Please outline the highest level of research skills you have achieved and where possible include evidence as an attachment to your application: 5. Employment i. of the following categories, which BEST describes your current employment status (Please select one) Full-time employee Part-time employee Self-employed not employing others Employer Employed unpaid worker in a family business Unemployed seeking full-time work Unemployed seeking part-time work Not employed not seeking employment ii. what is your current job title / designation? iii. Please outline your relevant experience and employment date (from/t0) employer position held /main duties iv. Of the following categories, select the ONE that best describes your main reason for undertaking this course To get a job To develop my existing business To start my own business To try for a different career To get a better job or promotion It was a requirement of my job I want extra skills for my job To get into another course of study For personal interest or self-development Other: 3 V0005 CRICOS IPC 03567C Higher Education ID PRV14008 ACN 135 762 426
6. Genuine Temporary Entrant (GTE) Requirements EIT needs to verify that you are a Genuine Temporary Entrant (GTE). In order for us to do this please provide a written statement explaining: your reasons for choosing to study in Australia rather than in your home country your reasons for choosing EIT your reasons for choosing to undertake the course of study specified in your application the relevance of your intended course/s to your academic and/or employment background the relevance of the course/s to your future career/educational plans Please attach any evidence that will help demonstrate that you are a GTE. For example if you are studying in a particular industry because your home country has a need for more staff within this industry evidence of current employment advertisements from your country may assist. If EIT considers that an applicant is a not a Genuine Temporary Entrant admission to the college will not be granted. Please provide your written statement here (include further documents or evidence as necessary): 4 V0005 CRICOS IPC 03567C Higher Education ID PRV14008 ACN 135 762 426
7. Program Specifics i. Are there any specific Units in this course in which you are already competent or have experience, and would like to apply for credit? yes no Please list the units: ii. Where did you hear about this program? (Please select the most relevant option) Searching online (e.g., Google, Yahoo, etc.) [EL2] Recommendation from friend/colleague [EL3] Received email [EL12] IDC Technologies [EL11] Social media (e.g., LinkedIn, Facebook, etc.) [EL21] Findcourses [EL22] International Society of Automation (ISA) [EL18] IEEE [EL19] Engineering News South Africa [EL5] Advertisement/Insert in magazine (please specify): [EL6] Other (please specify): 8. Visa Information i. Do you hold a valid Australian visa? yes no visa expiry (dd/mm/yyyy): ii. Have you ever held a visa from any other country? yes no If yes, which country and for how long? iii. Have you ever had a visa application rejected? yes no If yes, please provide details below: iv. have you ever breached any visa conditions? yes no If yes, please provide details below: v. Have you visited or studied in Australia previously? yes no vi. Please provide details of ANY spouse or dependents who you intend to include on your visa application and will accompany you to australia (including relationship and date of birth) vii. Have you ever been convicted of any criminal activity? yes no If yes, please provide details. 5 V0005 CRICOS IPC 03567C Higher Education ID PRV14008 ACN 135 762 426
9. Living and Studying Costs i. How will you study and live in Australia? Self-funded Sponsored by government/family/employer/other Bank Loan Other (please specify): Please visit the following website for applicable tuition fees: www.eit.edu.au/on-campus-students Please refer to the Pre-Departure Handbook available at www.eit.edu.au/on-campus-students for information on living costs. ii. Do you understand the tuition fees associated with your program of choice? yes no iii. Do you understand the costs associated with studying in Australia? yes no PLEASE NOTE Students, or the person paying the tuition fees on their behalf, are able to pay more than the minimum required tuition fee deposit before they start a course if they wish to. The ESOS Act requires that this be a student s choice. A student can pay full fees if they wish to. EIT requires a minimum of the first semester tuition fee to be paid prior to students starting their course. Students can choose to pay more than the first semester tuition fee before they start their course if they wish to, but EIT does not require it. 10. Application Fee A non-refundable application fee of AUD $100 is required. Please note that no other payment is required at this point. Please charge my Credit card: Card Type: MASTERCARD VISA Card No: CARDHOLDER S NAME: CARDHOLDER S SIGNATURE: EXPIRY DATE: MM / YY On the reverse of your card, above the signature, is a security number. In order to approve your card transaction, we require the last 3 digits: If the Cardholder's address is not the same as shown above please select this box: If you would prefer us to contact you for your card s expiry and security code, please select this box: 11. Overseas Student Health Cover (OSHC) EIT has a preferred supplier agreement for OSHC with Allianz (details of the Allianz OSHC are available here: https://allianzassistancehealth.com.au/en/student-visa-oshc/) Alternatively you can organise your own OSHC if you prefer. Please refer to this link to guide you http://www.health.gov.au/internet/main/publishing.nsf/content/overseas+student+health+cover+faq-1#insurersofferoshc If you do choose to organise your own OSHC you must provide EIT with proof of this before we can issue a Confirmation of Enrolment (CoE). Would you like EIT to organise your Overseas Student Health Cover? yes no Please continue to the next page to complete the Terms and Conditions 6 V0005 CRICOS IPC 03567C Higher Education ID PRV14008 ACN 135 762 426
12. Privacy, Disclosure and Declaration Our Commitment to Privacy: All personal information collected by EIT is protected by the provisions of The Privacy Act. Any information obtained is used only for the purposes for which it was provided. Under its national reporting obligations EIT may be required to supply information to Government agencies for statistics, research or program evaluations. No other disclosure will be made without the permission of the provider. EIT takes all reasonable steps to protect the security of information held whether stored in electronic or hard copy form. Access is available to the person whose information is held by EIT unless specifically excluded by statute. Our full privacy policy is available at www.eit.edu.au. Disclosure: I understand that the information provided here is to be used in line with the Privacy Statement above and should EIT provide a place for me, my success will depend upon my own efforts. Declaration: I declare that I have read and understood all the information that EIT has provided to me including program information and the Policies and Procedures (available at www.eit.edu.au/organisation-policies). I also accept the above terms and conditions and confirm all the information I have submitted is correct and complete. I understand that the information I have provided may be released to government agencies as required by law. I further understand that it may be disclosed to third parties for the purpose of progressing my application. I authorise EIT to seek verification of my academic and professional qualifications and employment. I acknowledge that I have read and understand the description of the program/s that I am applying for on EIT s website. I authorise EIT to access the Australian immigration Visa Entitlements Verification Online (VEVO) system at any time to obtain information on my visa status. I declare that I am a genuine temporary entrant and genuine student and that I have read and understood conditions relating to requirements outlined on www.immi.gov.au I am aware of the tuition and living costs of my stay in Australia and have the financial capacity to meet such costs for the duration of my course. I will make timely payments of any fees or associated costs. Please check the following boxes to confirm that you have included: Passport English language proficiency evidence Certified copies of academic transcripts and awards/certificates A full and complete EIT application form A completed GTE statement (on page 4 of the application form/or separate Statement of Purpose) CV/Resume SIGNATURE: DATE (dd/mm/yyyy): Agent s declaration (if applicable) From my assessment of the applicant they are a genuine temporary entrant and genuine student (as defined by DIAC). The applicant did not disclose any conclusive grounds for rejecting the applicant s declarations that they are a genuine temporary entrant and a genuine student. To the best of my knowledge, the applicant is genuine in making this application and has every intention of completing all programs listed in the application. The documents which form part of this application appear to be authentic and valid. To the best of my knowledge the applicant has genuine access to the total funds required, while in Australia, to cover all travel, OSHC, tuition and living costs for themselves and their family members (if applicable). I recommend EIT proceed with the assessment for admission of this applicant. I confirm the student has signed this application form. I have provided the student s personal email address and residential address, as disclosed to me by the student. agency name: agency staff member name: SIGNATURE: DATE (dd/mm/yyyy): 7 V0005 CRICOS IPC 03567C Higher Education ID PRV14008 ACN 135 762 426