International Students Application Form

Please check one of the following:

Change of Course

Name and Contact Information

Student Number (if applicable)

1. Family Name:____________________________________________________________________________________________________
2. Given Name: ____________________________________________________________________________________________________

Preferred Name:_________________________________________________________________________________________________

Management Academy
3. Partner Correspondence Address: __Bangalore
____________________________________________

Siddhi, No 29/3, Siddha Reddy Layout, Near Outer Ring Road, Doddanekundi Cross
__Yeshaas
__________________________________________________________________________

560037
__Bangalore
__________________________________________________________________________

Mobile: _____________________________________________________________________

[email protected]
E-mail: _____________________________________________________________________

Telephone: (Country Code) ___ (Area Code) _____ (Phone No) _____________________

Stamp/Contact Details

4. Applicant Address:____________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

E-mail: _____________________________________________________________________

Telephone: (Country Code) ___ (Area Code) _____ (Phone No) _____________________

5. Date of Birth:
6. Sex: Male

D D M M Y

Female

7. Country of Birth:_________________________________________________________________________________________________
8. Nationality/Citizenship:_ __________________________________________________________________________________________

Proposed Program
9. Course Commencement Date:

D D M M Y

10. Course: ___________________________________________________

Course Code: _____________

2nd Major: ___________________________________

Specialisation/1st Major: ____________________________________

English Language Proficiency

Have you completed a degree or other tertiary qualification in English?

Yes

No

Qualifications
13. Please attach certified copies of all academic records. A certified copy is a photocopy stamped and signed by a public notary or
education institution representative.

Please list all qualifications obtained starting from your final secondary year.
Name of Institution

Name of Award

Course
Duration

Years Attended
From/To
/
/
/
/

CRICOS Institution Provider Code 00279B.

Completed
Y/N

Other Information
14. Disability Declaration: Do you have a disability or any long term medical condition which may effect your studies? Yes

No

If yes please indicate the area of impairment to enable the University to provide assistance:

Hearing

Other: please indicate_____________________________________________________________________________________________

Learning

Mobility

Vision

Medical

15. Do you permit ECU to provide information to your nominated sponsor/guardian or scholarship body? Yes

No

Required Documents
All Students:
Application Form

Certified Academic Documents

Certified English Proficiency Documents

I have attached the above mentioned documents

Yes

No

Document Submission
By e-mail: [email protected]
Please note that you must include certified copies of your documents and official translated copies if the original is not in English.

Declaration
1. I declare that the information provided by me in this application is true and correct. I acknowledge that Edith Cowan University reserves the right
to make such enquiries as may be reasonably necessary to verify the information provided by me in this application including, with regard to my
educational qualifications.
2. I understand that providing false and misleading information to obtain admission and/or credit into a course is an offence.
3. I confirm
a. I have made my own enquiries as to the suitability of the course that I am seeking to be enrolled; and
b. That it is my sole responsibility to ensure that my enrolment is in accordance with the Admissions Enrolment and Academic Progress Rules of
Edith Cowan University.
4. I acknowledge and agree that the information provided by me to Edith Cowan University may be provided to Commonwealth and State agencies
when required by law.
5. If I am admitted into a course with Edith Cowan University I agree to comply with the Statutes, By-laws, Rules and Regulations of Edith Cowan
University.
6. I acknowledge I have had the opportunity to peruse the Statutes, By-laws, Rules and Regulations of Edith Cowan University at
www.ecu.edu.au/GPPS/governance_services/legislation.html
7. I acknowledge that official communication by Edith Cowan University to me will be by electronic means unless alternative communication
arrangements have been agreed by ECU.
8. I agree to notify ECU of any changes to my residential addresses.
If you have concerns about any of the above items please contact ECU International via email at [email protected].

Student Signature: _____________________________________________________________Date:_________________________________