CONFIDENTIAL
Ref:
TRANSNATIONAL ADMISSION FORM
Student Photo
Division of Information Technology, Engineering and the (2 copies)
Environment 35x45mm
Application for admission to:
Bachelor of Engineering (Electrical)
Bachelor of Engineering (Electronic)
Bachelor of Engineering (Mechanical)
Bachelor of Engineering (Telecommunications)
Bachelor of Technology in Product Design & Innovation
Application closing date:
UniSA ID number:
Partner ID number:
Before submitting this application, please ensure that you have attached all items required in the checklist under ‘Student
Declaration’ (section 8)
Australian citizens cannot enrol in transnational (offshore) programs.
Section 1. Personal details (please print clearly):
Full name exactly as it
appears on your
passport/identity card:
Family name:
First name:
Middle/Generation name:
Mr/Miss/Ms/Mrs: Gender: Male Female Date of birth: (dd/mm/yyyy) ______/______/_________
Country of birth: Country of citizenship:
Home and Business Addresses:
Street 1:
Home Street 2:
address: Suburb: City:
State: Country: Postcode:
Business/Organisation: Job title:
Street 1:
Business Street 2:
address: Suburb: City:
State: Country: Postcode:
Please send all correspondence to: Home Business
Email addresses:
Personal: Business:
Telephone numbers (please include country and area codes):
Home: Mobile/pager:
Business: Business fax:
Transnational Application for Admission Page 1 of 6
Current at December 2009
CRICOS Provider Number 00121B
Section 2. Education and qualification details (please print clearly):
List all tertiary education/secondary education or post-secondary courses attempted including any in the current year,
and attach Official Transcripts in English
Name of Name of qualification Language of No. of Years attended Completed Transcript
institution instruction (F-full time (circle one) attached (circle
P-part time one)
Circle one)
F
Yes / No Yes / No
P
F
Yes / No Yes / No
P
F
Yes / No Yes / No
P
F
Yes / No Yes / No
P
Have you ever been precluded from further study at this University or any other institution? Yes / No
If Yes, please give details:
_________________________________________________________
_________________________________________________________
_________________________________________________________
If you have studied at the University of South Australia prior to this
application what was your previous Student ID number:
Section 3. English language proficiency
Have you studied at secondary or tertiary levels with English
Is English your first language? Yes No
as the language of instruction? Yes No
Are you currently enrolled in, or have you previously undertaken English Language Studies?
Please provide details in the space below and attach evidence of English Standard achieved.
Date of course: Level: Institution:
IELTS overall score (academic): Paper-based TOEFL score:
Computer-based TOEFL score: Test date:
Certificate of Proficiency in English (University of Cambridge Certificate of Proficiency in Advanced English (University of
ESOL examination) score: Cambridge ESOL examination) score:
IELTS Test report, TOEFL Official Score Report or University of Cambridge ESOL examination must be attached to
application where applicable
Section 4. Employment and work experience
Dates Full/Part Time
Current employer Current position From To (circle one)
F/P
Sponsored by organisation: Yes No
Dates Full/Part Time
Previous employer Previous position From To (circle one)
F/P
Transnational Application for Admission Page 2 of 6
Current at December 2009
CRICOS Provider Number 00121B
Section 5. Statistical information (all questions must be answered)
Section 5a. Bio-Demographic
Are you a citizen of either Australia or New Zealand? Yes No
Do you have Permanent Resident status for either Australia or New Zealand? Yes No
Section 5b. Language
Do you speak a language other than English at your permanent home residence? Yes No, English only
If you answered yes, please provide the non-English language that is spoken most often ______________________________
Section 5c. Disability/Impairment details
Do you have a disability, impairment or long-term medical condition, which may affect your studies? Yes No
If you answered yes, please tick the area of impairment below:
Hearing Learning Mobility Vision Medical Other
If you ticked Other, please provide details of disability, impairment or long-term medical condition
_________________________________________________________
_________________________________________________________
Would you like to receive information about University and Partner support services, equipment and facilities that may assist
you, and how to access them. Yes No
Note: Information you provide about your disability or medical condition will be managed in accordance with the University
policy on confidentiality of student’s personal information.
Section 5d. Self Education (all questions must be answered)
What education had you completed before your current program?
POST-GRADUATE program of any type (Higher Doctorate, PhD, Master’s Preliminary or Qualifying, PG Certificate etc)
a) Never commenced
b) Commenced but not all requirements completed
c) Completed all requirements of the award
If you answered (b) or (c), please provide Start Year (yyyy) ____________ and End Year (yyyy) ____________
BACHELOR DEGREE
a) Never commenced
b) Commenced but not all requirements completed
c) Completed all requirements of the award
If you answered (b) or (c), please provide Start Year (yyyy) ____________ and End Year (yyyy) ____________
FINAL YEAR OF SECONDARY EDUCATION at a High School, Technical High School, Secondary School or College
a) Did not do final year
b) Did final year
If you answered (b), please provide:
The year in which you completed the final year of secondary education (yyyy) ____________
OTHER QUALIFICATION or certificate of attainment or competence
a) Do not have
b) Do have
If you answered (b), please provide:
The year in which you completed the qualification or certification (yyyy) ____________
Transnational Application for Admission Page 3 of 6
Current at December 2009
CRICOS Provider Number 00121B
Section 5e. Parental or Guardian Education
The Australian Department of Education, Employment and Workplace Relations (DEEWR) requires Australian Universities to
collect data from all students regarding the highest educational attainment of their parents/guardians.
This includes data relating to transnational students.
Parent/Guardian 1 and Parent/Guardian 2 are the people that you choose to identify in these roles.
Please refer to the attached Frequently Asked Questions document for further information.
http://www.unisa.edu.au/sas/processes/transnational_faq.asp
PARENT/GUARDIAN 1 – Highest Educational Attainment
I do not wish to provide this information
Postgraduate qualification (eg Graduate Diploma, Masters, PhD)
Bachelor degree
Other post school qualification (eg VET Certificate, Associate Degree or Diploma)
Completed Year 12 schooling or equivalent (eg STPM, A Level or equivalent)
Completed Year 10 schooling or equivalent but did not complete Year 12 schooling or equivalent
Completed Year 10 schooling or equivalent (eg SPM, O Level or equivalent)
Did not complete Year 10 schooling or equivalent
Don’t know
Gender: Male Female
PARENT/GUARDIAN 2 – Highest Educational Attainment
I do not wish to provide this information
Postgraduate qualification (eg Graduate Diploma, Masters, PhD)
Bachelor degree
Other post school qualification (eg VET Certificate, Associate Degree or Diploma)
Completed Year 12 schooling or equivalent (eg STPM, A Level or equivalent)
Completed Year 10 schooling or equivalent but did not complete Year 12 schooling or equivalent
Completed Year 10 schooling or equivalent (eg SPM, O Level or equivalent)
Did not complete Year 10 schooling or equivalent
Don’t know
Gender: Male Female
Section 6. Additional information
Please indicate how you came to know about the University of South Australia’s program for which you are applying:
Newspaper ___________________
Brochure
Internet
Education Fair
From a current or past student of UniSA
From a friend or colleague
Section 7. Expression of interest
Please submit a one page statement outlining your motivation for seeking admission into this program and any other information
which you wish to be taken into account in support of your application.
Please check if this is a requirement of your program.
(please attach the statement to this application)
Transnational Application for Admission Page 4 of 6
Current at December 2009
CRICOS Provider Number 00121B
8. Student Declaration
Please complete the checklist to ensure your application is complete, incomplete applications will not be processed
I have completed all relevant parts of the application form
I have attached a copy of my Passport or Personal Identification Papers
I have attached Certified copies of any degrees, diplomas, certificates or official transcripts in English
I have attached Certified copies of IELTS Test Report Form, TOEFL Official Score Report or University of Cambridge ESOL
examination where applicable
I have attached two passport sized photos with names printed on the reverse side and signed by staff from your local
program administration office
I have attached a Statement of Interest (where applicable)
I AGREE TO BE RESPONSIBLE FOR:
Ensuring that the courses I am enrolled in meet the requirements of the program. I undertake to check my enrolment and
academic results on a regular basis through the myUniSA student portal.
Withdrawing by the relevant census date for deletion of a course from my record.
Reading the announcements on myUniSA student portal and my student email at least once a week, as the University’s
primary method of communication.
Familiarising myself and abiding by the University statutes, by-laws and policies as listed on the University Policies
webpage, and any other rules or guidelines established under the authority of the University as listed at
http://www.unisa.edu.au/staff/Policies/default.asp
Meeting my financial obligations to the University in full and by the due date provided to me. I understand that I will not be
permitted to enrol or graduate if I fail to do so.
I AUTHORISE THE UNIVERSITY TO:
Release my personal and academic information in accordance with the Confidentiality of Student’s Personal Information
policy at www.unisa.edu.au/policies/policies/academic/A46.asp
Test any work submitted by me for instances of plagiarism using text comparison software. I understand this will involve the
University or its contractor copying my work and storing it on a database to test work submitted by others, as described at
www.unisanet.unisa.edu.au/learningconnection/student/studying/integrity.asp
I hereby declare that the information I have provided on this form is true and factual. I agree to meet all financial obligations to
Kaplan Higher Education in full and by the due date provided to me, and understand that I will not be permitted enrolment or
graduation if I fail to do so.
I will comply with all conditions, rules, regulations of Kaplan Higher Education (as stated http://www.kaplan.com.sg and program
brochure/handbook.
Student signature: Date:
DISCLAIMER:
The University of South Australia reserves the right to cancel an intake for a Program if the minimal enrolment has not
been met, as per the relevant International Program Agreement and Schedule.
Transnational Application for Admission Page 5 of 6
Current at December 2009
CRICOS Provider Number 00121B
Lodging your application
The completed application package should be returned to:
The application package must contain the following items:
1. A duly completed application form (sections 1 – 6 of this form must be filled in)
2. Copy of Passport or Personal Identification Papers
3. Certified copies of any degrees, diplomas, certificates or official transcripts in English
4. Certified copies of IELTS Test Report Form or TOEFL Official Score Report where applicable or English
Standard Equivalent.
5. Two passport sized photos with name printed on reverse side and signed by Kaplan Higher Education Institute
Pte Ltd
6. Statement of interest (if applicable)
7. First instalment fee. Cheque should be crossed in favour of Kaplan Higher Education Institute Institute Pte Ltd
Note: admission and enrolment may be delayed if the necessary information has not been entered on the
form or the required documentation is not provided
The completed application package should be returned to:
Director, UniSA BEng/BTech Program
Kaplan Higher Education Institute Pte Ltd
Kaplan City Campus, 51 Cuppage Road, #02-01, Singapore 229469
Tel: (65) 6733 1877 Fax: (65) 6733 2977 BRN: 198600044N
Fee payment details (where applicable)
OFFICE USE ONLY
Application
Recommended Conditional
Not Recommended Provisional
Program Director’s signature: Date:
Conditions __________________________________________
Apply - details
__________________________________________
__________________________________________
__________________________________________
__________________________________________
__________________________________________
Transnational Application for Admission Page 6 of 6
Current at December 2009
CRICOS Provider Number 00121B
