COMMON APPLICATION FORM (Australia)
Students:
Please provide correct and accurate details, write your personal details as per your passport copy.
Counsellors:
Use this form only for Applied eligible institutions. Please do not e-mail this form to institutions directly .
Student Full Name
Counsellor Name IDP Office GULSHAN, DHAKA
COURSE PREFERENCES
Intake Feb Jul Sep-Nov Year:
INSTITUTION APPLICATION - I
Institution Name
Course Preference 1 CRICOS
Course Preference 2 CRICOS
Campus Location
INSTITUTION APPLICATION - II
Institution Name
Course Preference 1 CRICOS
Course Preference 2 CRICOS
Campus Location
INSTITUTION APPLICATION - III
Institution Name
Course Preference 1 CRICOS
Course Preference 2 CRICOS
Campus Location
Note for Counselors: If the student wants to apply for more options, please mention in the Task Notes
PERSONAL INFORMATION
Salutation: Mr. Miss Mrs. Dr Gender: Male Female
Name:
(As per the passport)
First Name Middle Name Last Name
Date of Birth: Marital Status: Marriage Date
(Single, Married, Divorced, Separated, Engaged, Widow)
Permanent Address in Home Country:
Street Name:
City State Post Code
Country
Email Address
Mobile No
Phone No
Correspondence Address in Home Country:
Street Name:
City State Post Code
Country
Passport & Visa Information:
Passport No Valid from Expiry Date
Country of Passport
Country of Citizenship
Country of Birth
Visa Rejection (from any country) Date of Rejection
Do you Currently hold a valid visa?
(Australia or any other Country)
(Self/Spouse)
Primary Language
Emergency Contact Details:
Name of the contact person
Relationship with Student
Date of Birth of the contact Person
Contact Number and Email Address
ACADEMIC HISTORY
Please provide details of last two highest qualifications including any current studies:
Name of the Institution Major/Degree Mode Study Study Status Country Medium of Start Date & Percentage
(Campus, Online (Completed, Instruction End Date
Distance) Ongoing,
Discontinued) (DD / MM /YYYY)
ENGLISH LANGUAGE PROFICIENCY
Please tick ONE of the following:
Taken Test Type: IELTS TOEFL iBT TOEFL Paper Cambridge CAE Cambridge CPE PTE
(Academic or General)
Test Date:
Test Reference Number:
Overall Score: Listening Reading Writing Speaking
FINANCIAL & SPONSORSHIP DETAILS
Primary Financial Source Self Family Funded (Government Funded) Bank Loan
Applying for External Scholarship Yes No
Scholarship Name
EMPLOYMENT HISTORY
Please provide details of your employment history starting with most recent work experience, for additional work experience attach CV
Start Date End Date Organization Name Designation Location
(DD-MM-YYYY) (DD-MM-YYYY)
Credit Transfer Details
Credit Transfer? Yes No
OSHC Details
OSHC Required? Yes, No
If “Yes” then click Single.: Dual.: multi-Family:
OSHC Arrange by: Student University
ADDITIONAL APPLICATION DETAILS
Have your previously studied in AU? Yes No
AU Institution Name
Student ID
Excluded from AU Institution? Yes No
Reason Excluded
Unlawful Stay Ever? Yes No
Unlawful Stay Reason
Relatives Details
Has Close Relatives in Australia? Yes No
Name of the Relative
Relation of student with the Relative
Address with Pin/Zip code
DEPENDENTS
Do you intend to bring your spouse with you to Australia? Yes No
Do you intend to bring your children with you to Australia? Yes No
How many children?
Date of birth of each child: Child 1 Child 2 Child 3
STUDENT DECLARATION
Signature:
(APPLICANT ONLY, not agent, not sponsor)
Applicants under 18 years:
(Parent/legal guardian signature)
Parent/legal guardian name:
Date:
