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Agent Homination Form
Form: Student Administration-Admissions 17 10512.019
Tnis forrrr is tc b* us*c i,; ni;irrraie an apprcved Edith Co*uan Un;versiiy educaiion agent to assist an api;iicarti',vith a
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A confirnration emaii wrii be seni to ihe agent upon approval.
Please ens{Jre al! s*cti*r"rs hel*w are ecmpieted by tlie applicant.
SECT|ON A: Siudent details
STUDENT ID
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STL'DENT GIVEN NAME (S) SOORJR
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$fCTiOi.l B: Agent details
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$ECTION e: Student declaraiion
;. I ;;inoii;e ;l-16 ;bi";s ic c*mmr:i"rr*:li,;.r': ln r:y !:ehaif in regards t* my application ic ECU.
2. i acknowledge that Edith Cowan Universit,v reseryes the right to make such enquiri=s es nra']", he reascnabli;
necessary to verify lhe information pr,:viCed by me in this appiication incl':ding, r,rith regard ir: ilv edi.;*aiicr,.ai
nrrnlifinetinnc
3. i uncerstand that providing false and misleading information to obtain admission andlor credit rnio a coijrse rs
an of{ence.
,4 I rnn{irm
a. I have made my own enquiries as to the suitability of the course that I am seeking lo be *rir",:ih.4: and
b. thet it is my soie responsibilityto ensure that my enrolment is in accordanc* wiih the A.rJmissrcns
Enroirnent and Academic Progress Rules of [dith Covran University.
5. Iacknowledge and agree that the information provided by me to Edith Cowan University may be nrovided tc
Commonweaith anci State agencies when required by law.
0. lf I am acirnitted into e ccurse with Edith Co'ran University I agree to comply with the Statutes. Bi'-la'ris iir:ies
and Regulations of Edith Cowan University.
7 . I ackncwiedEe i have had the opportunity io peruse lhe Statutes, By-laws, Ruies and Reguiaiiols of [diiir
Cowan University at:
S. lacknoivledge that aificiaicommunrcaiion hy Edith Cowan University to me r,viil be by electrc'rrr m**iis rrless
alternative communication arrangements have been agreed by ECU.
Agent Nomination Forrn
Form: Student Administration-Admissions 17 14512019
9 i agr'ee lo nctrl,"t ECLI lri:r;ry:;l':.i,',!es ti t',.:y r*sicentiai addr-esses wheiher iq Ausirala rr arcthei'113Lr1r1ry i!'ci
i0 aflj cnairge ;n ih-. *ontaci inioir':at;cn in the *r,,*ni sf an emergency.
li ycu have concerns about any of the above items please contact ECU Admissions on (61 8) 6304 5;71 *f +nail tc
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Wtter* a preylous agefl exi,sfs please rtate thatil is nof ECU-s responsibility ta infarm the prevtaus agenr o{ this
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Srudentsisnaiure: nate, 39 r*Ql
PLEASE FORWARB THE COMPLETED FORM TO [email protected]
