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EXPRESSION OF INTEREST

APPLICATION FORM

To obtain further information about an international program that may be of interest please complete the form below and submit online.

A representative of Study Connections Abroad will contact you promptly to discuss your options and step you through the rest of the process.

Note:Study Connections Abroad will not pass on any details, including your email address, to any third party without your prior consent, unless required by law.

Please note you must fill in the blank with * to process the form.thanks!

1.Program
Write the Program number(s) in which you are interested.
1.Exchange to a university abroad
2.Work experience/internship abroad
3.Language programs
4.Volunteer programs
5.Study Tours
*I am interested in or Other Programs(please specify)
*Country: (1st choice) (2nd choice) (3rd choice)
Dates of travel(approximate):year,month,date OR:
Australian Depature City:

2.Background Information
Name:(as shown on your passport)
*First name:
Middle name:
*Surname:
Sex: Male Female
Date of Birth:
Age:
Passport: Australian Other(nationality)
Address:
*Street Address:
*Suburb: *State: *Postcode:
Postal Address:(if different)
Street Address:
Suburb: State: Postcode:
Tel:home: *mobile:
*Email

3.Academic Background Information
Educational institution at which you are currently enrolled:
Student ID Number:
Title of course in which you are currently enrolled:
Are you an international student? Yes No
Language skills
*First Language:
Level of language skill: Low Medium High
Second Language:
Level of language skill: Low Medium High
Have you travelled abroad before? No Yes
Country: year:
Have you lived abroad before for an extended period? No Yes
If yes:Country: Year:
For how long?:
How did you learn about our programs?
Through:
My university/insitution My lecturer A friend
Searching the web Other(specify)
I am interested in receiving further information related to the international program(s) that I have selected above.
Thank you for submitting your interest. Study Connections Abroad will contact you by email within 3 days to confirm receipt of this Application Form