Enrolment Form-2

Please make sure you complete ALL sections of this form. Tick boxes where appropriate. Please submit a copy of your passport with your completed application form. Incomplete applications will cause processing delays.

Personal Information

MaleFemale

Given Name*

Family Name*

Date of Birth*

Country of Birth*

Nationality*

Passport Number*

Upload Passport Copy* (.JPEG .PNG or .PDF only. Maximum size 5MB.)

Upload Supporting Documents (if required) (.JPEG .PNG or .PDF only. Maximum size 5MB.)

VISA TYPE:* VisitorWorking HolidayStudentOther

IF Student (OSHC/insurance required?): YesNo

Contact Information

Address Line 1*

Address Line 2

Suburb / Town / City*

Province / State*

Country*

Postcode*

Email*

Phone

Mobile*

TPS Payment Option (for applications over 25 weeks)

Do you want to pay with TPS instalment plan? YesNo

Enrolment Information

COURSE - GENERAL ENGLISH

Starting Date:

Weeks:

Holiday Dates (subject to approval):

Further Study/Pathway Information (if applicable)

Do you have a package visa application? YesNo

Accommodation Information

Do you want Impact English College to arrange accommodation? YesNo

Agent Details

Are you represented by an Education Agent? Yes No

Enter the name of the Agent:

Student Declaration

I declare that the information contained in this application is true. I confirm that I have received and read a copy of Melbourne English College's current brochure and fully understood and agree to the Terms and Conditions of Enrolment.

Name

Date

Melbourne English College’s commitment is to ensure that every student is provided exemplary levels of support and flexibility to help them overcome any challenge and ultimately complete their training.
CRICOS: 03934G
ABN: 92 151 388 859

03 9749 7727

03 9642 5514

hello@mec.melbourne

Melbourne CBD

Level 1, 333 Queen Street, Melbourne, VIC-3000

WERRIBEE

42B Synnot Street, Werribee VIC 3030

Site by halfpricewebsites.com.au

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