TEMPORARY APPLICATION FORM
Transcript of TEMPORARY APPLICATION FORM
TEMPORARY APPLICATION FORMVICTORIAN GOVERNMENT SCHOOLSINTERNATIONAL STUDENT PROGRAM
Department of Education and Training
copy State of Victoria (Department of Education and Training) 2022
The copyright in this document is owned by the State of Victoria (Department of Education and Training) or in the case of some materials by third parties (third party materials) No part may be
reproduced by any process except in accordance with the provisions of the Copyright Act 1968 the National Education Access Licence for Schools (NEALS) (see below) or with permission
An educational institution situated in Australia which is not conducted for profit or a body responsible for administering such an institution may copy and communicate the materials other than third party materials for the educational purposes of the institution Authorised by the Department of Education and Training 2 Treasury Place East Melbourne Victoria 3002
This document is also available on the internet at wwwstudyvicgovau
International Education DivisionDepartment of Education and Training
GPO Box 4367 Melbourne Victoria 3001 Australia
Level 28 80 Collins Street Melbourne Victoria 3000 Australia
Tel +61 3 7022 1000
Email internationaleducationvicgovau
Web wwwstudyvicgovau
CRICOS Provider Name and Code Department of Education and Training 00861K
2
Instructions
Please answer all questions in all sections Write clearly in black ink using BLOCK LETTERS and tick boxes where appropriate We cannot assess your application if it is incomplete or unreadable
School Term Dates 2021 to 2023
Term 1 Term 2 Term 3 Term 4
202228 January
- 8 April 26 April - 24 June
11 July - 16 September
03 October - 20 December
202327 January
- 6 April 24 April - 23 June
10 July - 15 September
02 October - 20 December
202429 January - 28 March
15 April - 28 June
15 July - 20 September
07 October - 20 December
School staff planning day on the first day of term 1 Student attendance may not be required on this day Check with your school to confirm
Application Process
Step 1 Gather informationVisit wwwstudyvicgovau or contact our office for information on enrolment and studying at a Victorian government school Read the Terms Conditions and Policies available at httpswwwstudyvicgovauShared20DocumentsenTemporaryApplicationTermsConditionsPoliciespdf A DET accredited education agent can also assist you with selecting a school and lodging your application o find a DET accredited education agent visit httpswwwstudyvicgovauensearchagentsPages
Step 2 Apply for school enrolment
Complete this application form and return it with the required documents to the International Education Division (IED) or a DET accredited education agent
Please refer to the checklist on page 9 for a list of all required documents
Step 3 Application assessment
Applications received are assessed to determine whether a student meets the entry requirements to study in a Victorian government school Application assessment cannot commence until all required documents are received To avoid unnecessary delays be sure applications are signed and include all the required supporting documents
Step 4 Letter of Offer and Written Agreement
Successful applicants will receive a Letter of Offer and Written Agreement to review
Step 5 Sign Written Agreement
Return a copy of the Letter of Offer and Written Agreement signed by the parents legal guardian (and the student if aged 18 years and over) by the due date
Step 6 Receive an invoice
After submitting your signed Written Agreement you will be sent an invoice
Step 7 Pay your invoice
Please pay your invoice by the due date to secure your place in a Victorian government school
Step 8 Receive your Confirmation of Placement (CoP) Letter
Following acceptance and invoice payment you will receive a CoP Letter
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
This application form is for students on a
1 Tourist Visa and who want to study in Victoria for 8 to 12 weeks
OR
2 Bridging Visa and are waiting for a substantive visa decision
Apply online
You can also lodge your application via our online portal Please access it at httpswwwstudyvicgovau Benefits include faster processing of applications saving and resuming applications at any time and creating and managing multiple applications in one online system
ACRONYMS
COP Confirmation of Placement
DET Department of Education and Training
ISP International Student Program
Agent = Education agent
3
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
2022 Tuition Fees
Weeks Primary School (Pre-6)Junior Secondary School (Years 7-10)
Senior Secondary School (Years 11-12)
1 $308 $409 $459
2 $616 $818 $918
3 $924 $1227 $1377
4 $1232 $1636 $1836
5 $1540 $2045 $2295
6 $1848 $2454 $2754
7 $2156 $2863 $3213
8 $2464 $3272 $3672
9 $2772 $3681 $4131
10 $3080 $4090 $4590
11 $3388 $4499 $5049
12 $3696 $4908 $5508
Other fees Cost (Australian Dollars)
Application fee $302
Enrolment Amendment Fee $302
School Transfer Fee $748
Default Administration Fee $500
Refund Administration Fee $500
Tuition fees and other charges are subject to change and may vary from year to year Any increase in fees during the period of study will apply to new and continuing students
Enrolment and Fee Paymentbull All fees specified by the IED Department of
Education and Training (DET) must be paid in full before the student can commence
bull Fees are payable to the DET by BPAY Electronic Funds Transfer or credit card within Australia and credit card or telegraphic transfer from overseas
bull The IED is not responsible for monies paid to an agent or other third party by the student parent or legal guardian
Application Fee - non fundableYou will receive an invoice including the $292 application fee following lodgement of this form The application fee is non-refundable
Tuition FeesTuition fees do not cover books uniforms stationery school excursions or camps
To calculate fees payable
1 Decide the dates that you want to start and finish studying in Victoria
2 Note the term dates on page 3 and calculate how many weeks this will be
3 Using the lsquoWeeksrsquo column in the 2021 Tuition Fee table above determine the number of weeks you will be at school during the school term
4 Identify the relevant study column (Primary Junior Secondary or Senior Secondary)
4
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
International Student Program (ISP) ndash Key Policies
Student Behaviour Policy
bull Each school has a code of conduct welfare and accommodation policy that students must abide by while enrolled at their host school
bull It is important that students avoid activities that may endanger their safety the safety of others or that could lead to criminal charges
bull When a student does not fulfil the requirements of the host schoolrsquos policies and rules andor the student enters into activities that are unsafe a studentrsquos enrolment may be suspended or cancelled for misbehaviour
Privacy Policy
bull The enrolment form requests personal information about the applicant as well as the applicantrsquos family members The purpose of collecting this information is to allow DET the relevant Victorian government school(s) and other contracted organisations to register the applicant and allocate staff and resources to ensure hisher educational and welfare needs are met
Also the information may be shared with other government departments and contracted organisations concerned with the administration of the ISP offered in Victorian government schools
bull Information about the privacy policy can be obtained from wwweducationvicgovau or wwwstudyvicgovau
International Student Program (ISP) ndash Key Policies
Complaints Policy
bull DET is committed to managing complaints and appeals impartially promptly and confidentially
bull The formal investigation of a complaint will require that details of the complaint be lodged in writing
bull The handling of the complaint will commence within 10 working days of receipt of the complaint
bull There is no cost associated with lodging a complaint with DET
bull The identity of the complainant will be protected unless permission for disclosure is given
Complaints in relation to refunds
bull Students or parents have 28 days to lodge a formal written complaint from the date of the remittance advice of their refund
Submission of complaints
bull Any issues or complaints in relation to the ISP offered in Victorian government schools should be discussed with the IED of DET
bull Formal complaints should be submitted in writing to
Executive Director International Education Division Department of Education and Training
GPO Box 4367 Melbourne Victoria 3001 Australia
Consideration of complaints
bull The Executive Director IED DET will consider the formal complaint
bull After consideration of all of the available evidence the Executive Director IED DET may decide to uphold or dismiss the complaint
Please note This agreement and the availability of complaints and appeals processes does not remove the right to take further action under Australiarsquos consumer protection laws
5
Please keep a copy of this application for your own record and subsequent enquiry
1 Student Details
Family name
Given name
Date of birth D D M M Y Y Y Y Gender Male Female
Nationality on passport
Country of birth
In which country will you be applying for your visa
Passport number Expiry date D D M M Y Y Y Y
2 Contact Details
It is compulsory to complete these details
bull Please note a legal guardian in relation to a child refers to having the right to the daily care and control of the child and the right to make decisions for that child
bull Please include the contact details of the adults to contact with regard to the payment of all fees and in the event of any student emergencies
FatherrsquosLegal guardianrsquos family name
FatherrsquosLegal guardianrsquos given name
MotherrsquosLegal guardianrsquos family name
MotherrsquosLegal guardianrsquos given name
Family contact number (include country and area codes)
Family email address
Street Address
City StateProvince PostcodeZip
Country Phone (include country and area codes)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
6
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
3 Accommodation Details in Victoria
Please indicate who the student will live with Parent Relative or family friend
Family name Given name
Relationship to student
Street Address
City State Postcode
Phone Mobile
4 Sibling Details
Does the student have a brother or sister currently enrolled at a Victorian government school Yes No
If yes which school are they attending
Sibling name 1 Sibling student ID number
Sibling name 2 Sibling student ID number
Sibling name 3 Sibling student ID number
Sibling name 4 Sibling student ID number
5 Study Plan
Name of school GradeYear level
Commencement date D D M M Y Y Y Y End date D D M M Y Y Y Y
6 School Preferences
Please refer to wwwstudyvicgovau for a full list of Victorian government schools
The IED is able to offer enrolment based on the availability of places in a particular grade or year level in each school To assist in the placement of the student in a suitable school please provide a list of preferred schools and subjects
Preferred schoolsPreferred subjects (Year 11 students must complete this section)
bull bull EnglishEAL
bull bull
bull bull
bull bull
bull bull
7
7 Special Circumstances
The more information you provide will ensure that the student is placed in a school with the most appropriate support according to their needs
Has the student been diagnosed with a medical condition that a doctor should be aware of If so please provide details
Does the student have any special learning needs which the school needs to be aware of If so please provide details
8 Primary School Enrolment Immunisation Requirements
It is a legal requirement under Victoriarsquos Public Health and Wellbeing Act 2008 for parents to provide an immunisation status certificate to the primary school at the time of enrolment
For more information about how to obtain an immunisation status certificate please refer to the Department of Health website located at the following link httpswww2healthvicgovauApidownloadmedia7B5F1D6A9A-D91B-4FC1-AAF5-37A938B01AD27D~text=How20do20I20obtain20an20immunisation20status20certificate3Famptext=phone201800206532080920orChildhood20Immunisation20Register20(ACIR)
9 Checklist
The application process will not commence until the application form is complete and all necessary supporting documentation is provided to the IED of DET
Copies of the following original documents must be provided
bull in the original language
bull translated into English
bull certified as true copies of the original documents by an authorised person of the country concerned
Copy of original document
English translation
Certified as true copies of original
Document
na Birth certificate OR passport page
na na Evidence of visa (if available)
naProof of medical conditions and special learning needs (if applicable)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
8
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
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- Check Box 25 Off
- Text Field 23
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- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
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- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
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- Text Field 90
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- Text Field 62
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- Text Field 110
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- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
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- Text Field 73
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- Text Field 76
- Text Field 77
- Text Field 79
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- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
copy State of Victoria (Department of Education and Training) 2022
The copyright in this document is owned by the State of Victoria (Department of Education and Training) or in the case of some materials by third parties (third party materials) No part may be
reproduced by any process except in accordance with the provisions of the Copyright Act 1968 the National Education Access Licence for Schools (NEALS) (see below) or with permission
An educational institution situated in Australia which is not conducted for profit or a body responsible for administering such an institution may copy and communicate the materials other than third party materials for the educational purposes of the institution Authorised by the Department of Education and Training 2 Treasury Place East Melbourne Victoria 3002
This document is also available on the internet at wwwstudyvicgovau
International Education DivisionDepartment of Education and Training
GPO Box 4367 Melbourne Victoria 3001 Australia
Level 28 80 Collins Street Melbourne Victoria 3000 Australia
Tel +61 3 7022 1000
Email internationaleducationvicgovau
Web wwwstudyvicgovau
CRICOS Provider Name and Code Department of Education and Training 00861K
2
Instructions
Please answer all questions in all sections Write clearly in black ink using BLOCK LETTERS and tick boxes where appropriate We cannot assess your application if it is incomplete or unreadable
School Term Dates 2021 to 2023
Term 1 Term 2 Term 3 Term 4
202228 January
- 8 April 26 April - 24 June
11 July - 16 September
03 October - 20 December
202327 January
- 6 April 24 April - 23 June
10 July - 15 September
02 October - 20 December
202429 January - 28 March
15 April - 28 June
15 July - 20 September
07 October - 20 December
School staff planning day on the first day of term 1 Student attendance may not be required on this day Check with your school to confirm
Application Process
Step 1 Gather informationVisit wwwstudyvicgovau or contact our office for information on enrolment and studying at a Victorian government school Read the Terms Conditions and Policies available at httpswwwstudyvicgovauShared20DocumentsenTemporaryApplicationTermsConditionsPoliciespdf A DET accredited education agent can also assist you with selecting a school and lodging your application o find a DET accredited education agent visit httpswwwstudyvicgovauensearchagentsPages
Step 2 Apply for school enrolment
Complete this application form and return it with the required documents to the International Education Division (IED) or a DET accredited education agent
Please refer to the checklist on page 9 for a list of all required documents
Step 3 Application assessment
Applications received are assessed to determine whether a student meets the entry requirements to study in a Victorian government school Application assessment cannot commence until all required documents are received To avoid unnecessary delays be sure applications are signed and include all the required supporting documents
Step 4 Letter of Offer and Written Agreement
Successful applicants will receive a Letter of Offer and Written Agreement to review
Step 5 Sign Written Agreement
Return a copy of the Letter of Offer and Written Agreement signed by the parents legal guardian (and the student if aged 18 years and over) by the due date
Step 6 Receive an invoice
After submitting your signed Written Agreement you will be sent an invoice
Step 7 Pay your invoice
Please pay your invoice by the due date to secure your place in a Victorian government school
Step 8 Receive your Confirmation of Placement (CoP) Letter
Following acceptance and invoice payment you will receive a CoP Letter
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
This application form is for students on a
1 Tourist Visa and who want to study in Victoria for 8 to 12 weeks
OR
2 Bridging Visa and are waiting for a substantive visa decision
Apply online
You can also lodge your application via our online portal Please access it at httpswwwstudyvicgovau Benefits include faster processing of applications saving and resuming applications at any time and creating and managing multiple applications in one online system
ACRONYMS
COP Confirmation of Placement
DET Department of Education and Training
ISP International Student Program
Agent = Education agent
3
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
2022 Tuition Fees
Weeks Primary School (Pre-6)Junior Secondary School (Years 7-10)
Senior Secondary School (Years 11-12)
1 $308 $409 $459
2 $616 $818 $918
3 $924 $1227 $1377
4 $1232 $1636 $1836
5 $1540 $2045 $2295
6 $1848 $2454 $2754
7 $2156 $2863 $3213
8 $2464 $3272 $3672
9 $2772 $3681 $4131
10 $3080 $4090 $4590
11 $3388 $4499 $5049
12 $3696 $4908 $5508
Other fees Cost (Australian Dollars)
Application fee $302
Enrolment Amendment Fee $302
School Transfer Fee $748
Default Administration Fee $500
Refund Administration Fee $500
Tuition fees and other charges are subject to change and may vary from year to year Any increase in fees during the period of study will apply to new and continuing students
Enrolment and Fee Paymentbull All fees specified by the IED Department of
Education and Training (DET) must be paid in full before the student can commence
bull Fees are payable to the DET by BPAY Electronic Funds Transfer or credit card within Australia and credit card or telegraphic transfer from overseas
bull The IED is not responsible for monies paid to an agent or other third party by the student parent or legal guardian
Application Fee - non fundableYou will receive an invoice including the $292 application fee following lodgement of this form The application fee is non-refundable
Tuition FeesTuition fees do not cover books uniforms stationery school excursions or camps
To calculate fees payable
1 Decide the dates that you want to start and finish studying in Victoria
2 Note the term dates on page 3 and calculate how many weeks this will be
3 Using the lsquoWeeksrsquo column in the 2021 Tuition Fee table above determine the number of weeks you will be at school during the school term
4 Identify the relevant study column (Primary Junior Secondary or Senior Secondary)
4
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
International Student Program (ISP) ndash Key Policies
Student Behaviour Policy
bull Each school has a code of conduct welfare and accommodation policy that students must abide by while enrolled at their host school
bull It is important that students avoid activities that may endanger their safety the safety of others or that could lead to criminal charges
bull When a student does not fulfil the requirements of the host schoolrsquos policies and rules andor the student enters into activities that are unsafe a studentrsquos enrolment may be suspended or cancelled for misbehaviour
Privacy Policy
bull The enrolment form requests personal information about the applicant as well as the applicantrsquos family members The purpose of collecting this information is to allow DET the relevant Victorian government school(s) and other contracted organisations to register the applicant and allocate staff and resources to ensure hisher educational and welfare needs are met
Also the information may be shared with other government departments and contracted organisations concerned with the administration of the ISP offered in Victorian government schools
bull Information about the privacy policy can be obtained from wwweducationvicgovau or wwwstudyvicgovau
International Student Program (ISP) ndash Key Policies
Complaints Policy
bull DET is committed to managing complaints and appeals impartially promptly and confidentially
bull The formal investigation of a complaint will require that details of the complaint be lodged in writing
bull The handling of the complaint will commence within 10 working days of receipt of the complaint
bull There is no cost associated with lodging a complaint with DET
bull The identity of the complainant will be protected unless permission for disclosure is given
Complaints in relation to refunds
bull Students or parents have 28 days to lodge a formal written complaint from the date of the remittance advice of their refund
Submission of complaints
bull Any issues or complaints in relation to the ISP offered in Victorian government schools should be discussed with the IED of DET
bull Formal complaints should be submitted in writing to
Executive Director International Education Division Department of Education and Training
GPO Box 4367 Melbourne Victoria 3001 Australia
Consideration of complaints
bull The Executive Director IED DET will consider the formal complaint
bull After consideration of all of the available evidence the Executive Director IED DET may decide to uphold or dismiss the complaint
Please note This agreement and the availability of complaints and appeals processes does not remove the right to take further action under Australiarsquos consumer protection laws
5
Please keep a copy of this application for your own record and subsequent enquiry
1 Student Details
Family name
Given name
Date of birth D D M M Y Y Y Y Gender Male Female
Nationality on passport
Country of birth
In which country will you be applying for your visa
Passport number Expiry date D D M M Y Y Y Y
2 Contact Details
It is compulsory to complete these details
bull Please note a legal guardian in relation to a child refers to having the right to the daily care and control of the child and the right to make decisions for that child
bull Please include the contact details of the adults to contact with regard to the payment of all fees and in the event of any student emergencies
FatherrsquosLegal guardianrsquos family name
FatherrsquosLegal guardianrsquos given name
MotherrsquosLegal guardianrsquos family name
MotherrsquosLegal guardianrsquos given name
Family contact number (include country and area codes)
Family email address
Street Address
City StateProvince PostcodeZip
Country Phone (include country and area codes)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
6
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
3 Accommodation Details in Victoria
Please indicate who the student will live with Parent Relative or family friend
Family name Given name
Relationship to student
Street Address
City State Postcode
Phone Mobile
4 Sibling Details
Does the student have a brother or sister currently enrolled at a Victorian government school Yes No
If yes which school are they attending
Sibling name 1 Sibling student ID number
Sibling name 2 Sibling student ID number
Sibling name 3 Sibling student ID number
Sibling name 4 Sibling student ID number
5 Study Plan
Name of school GradeYear level
Commencement date D D M M Y Y Y Y End date D D M M Y Y Y Y
6 School Preferences
Please refer to wwwstudyvicgovau for a full list of Victorian government schools
The IED is able to offer enrolment based on the availability of places in a particular grade or year level in each school To assist in the placement of the student in a suitable school please provide a list of preferred schools and subjects
Preferred schoolsPreferred subjects (Year 11 students must complete this section)
bull bull EnglishEAL
bull bull
bull bull
bull bull
bull bull
7
7 Special Circumstances
The more information you provide will ensure that the student is placed in a school with the most appropriate support according to their needs
Has the student been diagnosed with a medical condition that a doctor should be aware of If so please provide details
Does the student have any special learning needs which the school needs to be aware of If so please provide details
8 Primary School Enrolment Immunisation Requirements
It is a legal requirement under Victoriarsquos Public Health and Wellbeing Act 2008 for parents to provide an immunisation status certificate to the primary school at the time of enrolment
For more information about how to obtain an immunisation status certificate please refer to the Department of Health website located at the following link httpswww2healthvicgovauApidownloadmedia7B5F1D6A9A-D91B-4FC1-AAF5-37A938B01AD27D~text=How20do20I20obtain20an20immunisation20status20certificate3Famptext=phone201800206532080920orChildhood20Immunisation20Register20(ACIR)
9 Checklist
The application process will not commence until the application form is complete and all necessary supporting documentation is provided to the IED of DET
Copies of the following original documents must be provided
bull in the original language
bull translated into English
bull certified as true copies of the original documents by an authorised person of the country concerned
Copy of original document
English translation
Certified as true copies of original
Document
na Birth certificate OR passport page
na na Evidence of visa (if available)
naProof of medical conditions and special learning needs (if applicable)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
8
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
Instructions
Please answer all questions in all sections Write clearly in black ink using BLOCK LETTERS and tick boxes where appropriate We cannot assess your application if it is incomplete or unreadable
School Term Dates 2021 to 2023
Term 1 Term 2 Term 3 Term 4
202228 January
- 8 April 26 April - 24 June
11 July - 16 September
03 October - 20 December
202327 January
- 6 April 24 April - 23 June
10 July - 15 September
02 October - 20 December
202429 January - 28 March
15 April - 28 June
15 July - 20 September
07 October - 20 December
School staff planning day on the first day of term 1 Student attendance may not be required on this day Check with your school to confirm
Application Process
Step 1 Gather informationVisit wwwstudyvicgovau or contact our office for information on enrolment and studying at a Victorian government school Read the Terms Conditions and Policies available at httpswwwstudyvicgovauShared20DocumentsenTemporaryApplicationTermsConditionsPoliciespdf A DET accredited education agent can also assist you with selecting a school and lodging your application o find a DET accredited education agent visit httpswwwstudyvicgovauensearchagentsPages
Step 2 Apply for school enrolment
Complete this application form and return it with the required documents to the International Education Division (IED) or a DET accredited education agent
Please refer to the checklist on page 9 for a list of all required documents
Step 3 Application assessment
Applications received are assessed to determine whether a student meets the entry requirements to study in a Victorian government school Application assessment cannot commence until all required documents are received To avoid unnecessary delays be sure applications are signed and include all the required supporting documents
Step 4 Letter of Offer and Written Agreement
Successful applicants will receive a Letter of Offer and Written Agreement to review
Step 5 Sign Written Agreement
Return a copy of the Letter of Offer and Written Agreement signed by the parents legal guardian (and the student if aged 18 years and over) by the due date
Step 6 Receive an invoice
After submitting your signed Written Agreement you will be sent an invoice
Step 7 Pay your invoice
Please pay your invoice by the due date to secure your place in a Victorian government school
Step 8 Receive your Confirmation of Placement (CoP) Letter
Following acceptance and invoice payment you will receive a CoP Letter
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
This application form is for students on a
1 Tourist Visa and who want to study in Victoria for 8 to 12 weeks
OR
2 Bridging Visa and are waiting for a substantive visa decision
Apply online
You can also lodge your application via our online portal Please access it at httpswwwstudyvicgovau Benefits include faster processing of applications saving and resuming applications at any time and creating and managing multiple applications in one online system
ACRONYMS
COP Confirmation of Placement
DET Department of Education and Training
ISP International Student Program
Agent = Education agent
3
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
2022 Tuition Fees
Weeks Primary School (Pre-6)Junior Secondary School (Years 7-10)
Senior Secondary School (Years 11-12)
1 $308 $409 $459
2 $616 $818 $918
3 $924 $1227 $1377
4 $1232 $1636 $1836
5 $1540 $2045 $2295
6 $1848 $2454 $2754
7 $2156 $2863 $3213
8 $2464 $3272 $3672
9 $2772 $3681 $4131
10 $3080 $4090 $4590
11 $3388 $4499 $5049
12 $3696 $4908 $5508
Other fees Cost (Australian Dollars)
Application fee $302
Enrolment Amendment Fee $302
School Transfer Fee $748
Default Administration Fee $500
Refund Administration Fee $500
Tuition fees and other charges are subject to change and may vary from year to year Any increase in fees during the period of study will apply to new and continuing students
Enrolment and Fee Paymentbull All fees specified by the IED Department of
Education and Training (DET) must be paid in full before the student can commence
bull Fees are payable to the DET by BPAY Electronic Funds Transfer or credit card within Australia and credit card or telegraphic transfer from overseas
bull The IED is not responsible for monies paid to an agent or other third party by the student parent or legal guardian
Application Fee - non fundableYou will receive an invoice including the $292 application fee following lodgement of this form The application fee is non-refundable
Tuition FeesTuition fees do not cover books uniforms stationery school excursions or camps
To calculate fees payable
1 Decide the dates that you want to start and finish studying in Victoria
2 Note the term dates on page 3 and calculate how many weeks this will be
3 Using the lsquoWeeksrsquo column in the 2021 Tuition Fee table above determine the number of weeks you will be at school during the school term
4 Identify the relevant study column (Primary Junior Secondary or Senior Secondary)
4
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
International Student Program (ISP) ndash Key Policies
Student Behaviour Policy
bull Each school has a code of conduct welfare and accommodation policy that students must abide by while enrolled at their host school
bull It is important that students avoid activities that may endanger their safety the safety of others or that could lead to criminal charges
bull When a student does not fulfil the requirements of the host schoolrsquos policies and rules andor the student enters into activities that are unsafe a studentrsquos enrolment may be suspended or cancelled for misbehaviour
Privacy Policy
bull The enrolment form requests personal information about the applicant as well as the applicantrsquos family members The purpose of collecting this information is to allow DET the relevant Victorian government school(s) and other contracted organisations to register the applicant and allocate staff and resources to ensure hisher educational and welfare needs are met
Also the information may be shared with other government departments and contracted organisations concerned with the administration of the ISP offered in Victorian government schools
bull Information about the privacy policy can be obtained from wwweducationvicgovau or wwwstudyvicgovau
International Student Program (ISP) ndash Key Policies
Complaints Policy
bull DET is committed to managing complaints and appeals impartially promptly and confidentially
bull The formal investigation of a complaint will require that details of the complaint be lodged in writing
bull The handling of the complaint will commence within 10 working days of receipt of the complaint
bull There is no cost associated with lodging a complaint with DET
bull The identity of the complainant will be protected unless permission for disclosure is given
Complaints in relation to refunds
bull Students or parents have 28 days to lodge a formal written complaint from the date of the remittance advice of their refund
Submission of complaints
bull Any issues or complaints in relation to the ISP offered in Victorian government schools should be discussed with the IED of DET
bull Formal complaints should be submitted in writing to
Executive Director International Education Division Department of Education and Training
GPO Box 4367 Melbourne Victoria 3001 Australia
Consideration of complaints
bull The Executive Director IED DET will consider the formal complaint
bull After consideration of all of the available evidence the Executive Director IED DET may decide to uphold or dismiss the complaint
Please note This agreement and the availability of complaints and appeals processes does not remove the right to take further action under Australiarsquos consumer protection laws
5
Please keep a copy of this application for your own record and subsequent enquiry
1 Student Details
Family name
Given name
Date of birth D D M M Y Y Y Y Gender Male Female
Nationality on passport
Country of birth
In which country will you be applying for your visa
Passport number Expiry date D D M M Y Y Y Y
2 Contact Details
It is compulsory to complete these details
bull Please note a legal guardian in relation to a child refers to having the right to the daily care and control of the child and the right to make decisions for that child
bull Please include the contact details of the adults to contact with regard to the payment of all fees and in the event of any student emergencies
FatherrsquosLegal guardianrsquos family name
FatherrsquosLegal guardianrsquos given name
MotherrsquosLegal guardianrsquos family name
MotherrsquosLegal guardianrsquos given name
Family contact number (include country and area codes)
Family email address
Street Address
City StateProvince PostcodeZip
Country Phone (include country and area codes)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
6
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
3 Accommodation Details in Victoria
Please indicate who the student will live with Parent Relative or family friend
Family name Given name
Relationship to student
Street Address
City State Postcode
Phone Mobile
4 Sibling Details
Does the student have a brother or sister currently enrolled at a Victorian government school Yes No
If yes which school are they attending
Sibling name 1 Sibling student ID number
Sibling name 2 Sibling student ID number
Sibling name 3 Sibling student ID number
Sibling name 4 Sibling student ID number
5 Study Plan
Name of school GradeYear level
Commencement date D D M M Y Y Y Y End date D D M M Y Y Y Y
6 School Preferences
Please refer to wwwstudyvicgovau for a full list of Victorian government schools
The IED is able to offer enrolment based on the availability of places in a particular grade or year level in each school To assist in the placement of the student in a suitable school please provide a list of preferred schools and subjects
Preferred schoolsPreferred subjects (Year 11 students must complete this section)
bull bull EnglishEAL
bull bull
bull bull
bull bull
bull bull
7
7 Special Circumstances
The more information you provide will ensure that the student is placed in a school with the most appropriate support according to their needs
Has the student been diagnosed with a medical condition that a doctor should be aware of If so please provide details
Does the student have any special learning needs which the school needs to be aware of If so please provide details
8 Primary School Enrolment Immunisation Requirements
It is a legal requirement under Victoriarsquos Public Health and Wellbeing Act 2008 for parents to provide an immunisation status certificate to the primary school at the time of enrolment
For more information about how to obtain an immunisation status certificate please refer to the Department of Health website located at the following link httpswww2healthvicgovauApidownloadmedia7B5F1D6A9A-D91B-4FC1-AAF5-37A938B01AD27D~text=How20do20I20obtain20an20immunisation20status20certificate3Famptext=phone201800206532080920orChildhood20Immunisation20Register20(ACIR)
9 Checklist
The application process will not commence until the application form is complete and all necessary supporting documentation is provided to the IED of DET
Copies of the following original documents must be provided
bull in the original language
bull translated into English
bull certified as true copies of the original documents by an authorised person of the country concerned
Copy of original document
English translation
Certified as true copies of original
Document
na Birth certificate OR passport page
na na Evidence of visa (if available)
naProof of medical conditions and special learning needs (if applicable)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
8
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
2022 Tuition Fees
Weeks Primary School (Pre-6)Junior Secondary School (Years 7-10)
Senior Secondary School (Years 11-12)
1 $308 $409 $459
2 $616 $818 $918
3 $924 $1227 $1377
4 $1232 $1636 $1836
5 $1540 $2045 $2295
6 $1848 $2454 $2754
7 $2156 $2863 $3213
8 $2464 $3272 $3672
9 $2772 $3681 $4131
10 $3080 $4090 $4590
11 $3388 $4499 $5049
12 $3696 $4908 $5508
Other fees Cost (Australian Dollars)
Application fee $302
Enrolment Amendment Fee $302
School Transfer Fee $748
Default Administration Fee $500
Refund Administration Fee $500
Tuition fees and other charges are subject to change and may vary from year to year Any increase in fees during the period of study will apply to new and continuing students
Enrolment and Fee Paymentbull All fees specified by the IED Department of
Education and Training (DET) must be paid in full before the student can commence
bull Fees are payable to the DET by BPAY Electronic Funds Transfer or credit card within Australia and credit card or telegraphic transfer from overseas
bull The IED is not responsible for monies paid to an agent or other third party by the student parent or legal guardian
Application Fee - non fundableYou will receive an invoice including the $292 application fee following lodgement of this form The application fee is non-refundable
Tuition FeesTuition fees do not cover books uniforms stationery school excursions or camps
To calculate fees payable
1 Decide the dates that you want to start and finish studying in Victoria
2 Note the term dates on page 3 and calculate how many weeks this will be
3 Using the lsquoWeeksrsquo column in the 2021 Tuition Fee table above determine the number of weeks you will be at school during the school term
4 Identify the relevant study column (Primary Junior Secondary or Senior Secondary)
4
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
International Student Program (ISP) ndash Key Policies
Student Behaviour Policy
bull Each school has a code of conduct welfare and accommodation policy that students must abide by while enrolled at their host school
bull It is important that students avoid activities that may endanger their safety the safety of others or that could lead to criminal charges
bull When a student does not fulfil the requirements of the host schoolrsquos policies and rules andor the student enters into activities that are unsafe a studentrsquos enrolment may be suspended or cancelled for misbehaviour
Privacy Policy
bull The enrolment form requests personal information about the applicant as well as the applicantrsquos family members The purpose of collecting this information is to allow DET the relevant Victorian government school(s) and other contracted organisations to register the applicant and allocate staff and resources to ensure hisher educational and welfare needs are met
Also the information may be shared with other government departments and contracted organisations concerned with the administration of the ISP offered in Victorian government schools
bull Information about the privacy policy can be obtained from wwweducationvicgovau or wwwstudyvicgovau
International Student Program (ISP) ndash Key Policies
Complaints Policy
bull DET is committed to managing complaints and appeals impartially promptly and confidentially
bull The formal investigation of a complaint will require that details of the complaint be lodged in writing
bull The handling of the complaint will commence within 10 working days of receipt of the complaint
bull There is no cost associated with lodging a complaint with DET
bull The identity of the complainant will be protected unless permission for disclosure is given
Complaints in relation to refunds
bull Students or parents have 28 days to lodge a formal written complaint from the date of the remittance advice of their refund
Submission of complaints
bull Any issues or complaints in relation to the ISP offered in Victorian government schools should be discussed with the IED of DET
bull Formal complaints should be submitted in writing to
Executive Director International Education Division Department of Education and Training
GPO Box 4367 Melbourne Victoria 3001 Australia
Consideration of complaints
bull The Executive Director IED DET will consider the formal complaint
bull After consideration of all of the available evidence the Executive Director IED DET may decide to uphold or dismiss the complaint
Please note This agreement and the availability of complaints and appeals processes does not remove the right to take further action under Australiarsquos consumer protection laws
5
Please keep a copy of this application for your own record and subsequent enquiry
1 Student Details
Family name
Given name
Date of birth D D M M Y Y Y Y Gender Male Female
Nationality on passport
Country of birth
In which country will you be applying for your visa
Passport number Expiry date D D M M Y Y Y Y
2 Contact Details
It is compulsory to complete these details
bull Please note a legal guardian in relation to a child refers to having the right to the daily care and control of the child and the right to make decisions for that child
bull Please include the contact details of the adults to contact with regard to the payment of all fees and in the event of any student emergencies
FatherrsquosLegal guardianrsquos family name
FatherrsquosLegal guardianrsquos given name
MotherrsquosLegal guardianrsquos family name
MotherrsquosLegal guardianrsquos given name
Family contact number (include country and area codes)
Family email address
Street Address
City StateProvince PostcodeZip
Country Phone (include country and area codes)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
6
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
3 Accommodation Details in Victoria
Please indicate who the student will live with Parent Relative or family friend
Family name Given name
Relationship to student
Street Address
City State Postcode
Phone Mobile
4 Sibling Details
Does the student have a brother or sister currently enrolled at a Victorian government school Yes No
If yes which school are they attending
Sibling name 1 Sibling student ID number
Sibling name 2 Sibling student ID number
Sibling name 3 Sibling student ID number
Sibling name 4 Sibling student ID number
5 Study Plan
Name of school GradeYear level
Commencement date D D M M Y Y Y Y End date D D M M Y Y Y Y
6 School Preferences
Please refer to wwwstudyvicgovau for a full list of Victorian government schools
The IED is able to offer enrolment based on the availability of places in a particular grade or year level in each school To assist in the placement of the student in a suitable school please provide a list of preferred schools and subjects
Preferred schoolsPreferred subjects (Year 11 students must complete this section)
bull bull EnglishEAL
bull bull
bull bull
bull bull
bull bull
7
7 Special Circumstances
The more information you provide will ensure that the student is placed in a school with the most appropriate support according to their needs
Has the student been diagnosed with a medical condition that a doctor should be aware of If so please provide details
Does the student have any special learning needs which the school needs to be aware of If so please provide details
8 Primary School Enrolment Immunisation Requirements
It is a legal requirement under Victoriarsquos Public Health and Wellbeing Act 2008 for parents to provide an immunisation status certificate to the primary school at the time of enrolment
For more information about how to obtain an immunisation status certificate please refer to the Department of Health website located at the following link httpswww2healthvicgovauApidownloadmedia7B5F1D6A9A-D91B-4FC1-AAF5-37A938B01AD27D~text=How20do20I20obtain20an20immunisation20status20certificate3Famptext=phone201800206532080920orChildhood20Immunisation20Register20(ACIR)
9 Checklist
The application process will not commence until the application form is complete and all necessary supporting documentation is provided to the IED of DET
Copies of the following original documents must be provided
bull in the original language
bull translated into English
bull certified as true copies of the original documents by an authorised person of the country concerned
Copy of original document
English translation
Certified as true copies of original
Document
na Birth certificate OR passport page
na na Evidence of visa (if available)
naProof of medical conditions and special learning needs (if applicable)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
8
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
TEMPORARY INTERNATIONAL STUDENT APPLICATION FORM
International Student Program (ISP) ndash Key Policies
Student Behaviour Policy
bull Each school has a code of conduct welfare and accommodation policy that students must abide by while enrolled at their host school
bull It is important that students avoid activities that may endanger their safety the safety of others or that could lead to criminal charges
bull When a student does not fulfil the requirements of the host schoolrsquos policies and rules andor the student enters into activities that are unsafe a studentrsquos enrolment may be suspended or cancelled for misbehaviour
Privacy Policy
bull The enrolment form requests personal information about the applicant as well as the applicantrsquos family members The purpose of collecting this information is to allow DET the relevant Victorian government school(s) and other contracted organisations to register the applicant and allocate staff and resources to ensure hisher educational and welfare needs are met
Also the information may be shared with other government departments and contracted organisations concerned with the administration of the ISP offered in Victorian government schools
bull Information about the privacy policy can be obtained from wwweducationvicgovau or wwwstudyvicgovau
International Student Program (ISP) ndash Key Policies
Complaints Policy
bull DET is committed to managing complaints and appeals impartially promptly and confidentially
bull The formal investigation of a complaint will require that details of the complaint be lodged in writing
bull The handling of the complaint will commence within 10 working days of receipt of the complaint
bull There is no cost associated with lodging a complaint with DET
bull The identity of the complainant will be protected unless permission for disclosure is given
Complaints in relation to refunds
bull Students or parents have 28 days to lodge a formal written complaint from the date of the remittance advice of their refund
Submission of complaints
bull Any issues or complaints in relation to the ISP offered in Victorian government schools should be discussed with the IED of DET
bull Formal complaints should be submitted in writing to
Executive Director International Education Division Department of Education and Training
GPO Box 4367 Melbourne Victoria 3001 Australia
Consideration of complaints
bull The Executive Director IED DET will consider the formal complaint
bull After consideration of all of the available evidence the Executive Director IED DET may decide to uphold or dismiss the complaint
Please note This agreement and the availability of complaints and appeals processes does not remove the right to take further action under Australiarsquos consumer protection laws
5
Please keep a copy of this application for your own record and subsequent enquiry
1 Student Details
Family name
Given name
Date of birth D D M M Y Y Y Y Gender Male Female
Nationality on passport
Country of birth
In which country will you be applying for your visa
Passport number Expiry date D D M M Y Y Y Y
2 Contact Details
It is compulsory to complete these details
bull Please note a legal guardian in relation to a child refers to having the right to the daily care and control of the child and the right to make decisions for that child
bull Please include the contact details of the adults to contact with regard to the payment of all fees and in the event of any student emergencies
FatherrsquosLegal guardianrsquos family name
FatherrsquosLegal guardianrsquos given name
MotherrsquosLegal guardianrsquos family name
MotherrsquosLegal guardianrsquos given name
Family contact number (include country and area codes)
Family email address
Street Address
City StateProvince PostcodeZip
Country Phone (include country and area codes)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
6
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
3 Accommodation Details in Victoria
Please indicate who the student will live with Parent Relative or family friend
Family name Given name
Relationship to student
Street Address
City State Postcode
Phone Mobile
4 Sibling Details
Does the student have a brother or sister currently enrolled at a Victorian government school Yes No
If yes which school are they attending
Sibling name 1 Sibling student ID number
Sibling name 2 Sibling student ID number
Sibling name 3 Sibling student ID number
Sibling name 4 Sibling student ID number
5 Study Plan
Name of school GradeYear level
Commencement date D D M M Y Y Y Y End date D D M M Y Y Y Y
6 School Preferences
Please refer to wwwstudyvicgovau for a full list of Victorian government schools
The IED is able to offer enrolment based on the availability of places in a particular grade or year level in each school To assist in the placement of the student in a suitable school please provide a list of preferred schools and subjects
Preferred schoolsPreferred subjects (Year 11 students must complete this section)
bull bull EnglishEAL
bull bull
bull bull
bull bull
bull bull
7
7 Special Circumstances
The more information you provide will ensure that the student is placed in a school with the most appropriate support according to their needs
Has the student been diagnosed with a medical condition that a doctor should be aware of If so please provide details
Does the student have any special learning needs which the school needs to be aware of If so please provide details
8 Primary School Enrolment Immunisation Requirements
It is a legal requirement under Victoriarsquos Public Health and Wellbeing Act 2008 for parents to provide an immunisation status certificate to the primary school at the time of enrolment
For more information about how to obtain an immunisation status certificate please refer to the Department of Health website located at the following link httpswww2healthvicgovauApidownloadmedia7B5F1D6A9A-D91B-4FC1-AAF5-37A938B01AD27D~text=How20do20I20obtain20an20immunisation20status20certificate3Famptext=phone201800206532080920orChildhood20Immunisation20Register20(ACIR)
9 Checklist
The application process will not commence until the application form is complete and all necessary supporting documentation is provided to the IED of DET
Copies of the following original documents must be provided
bull in the original language
bull translated into English
bull certified as true copies of the original documents by an authorised person of the country concerned
Copy of original document
English translation
Certified as true copies of original
Document
na Birth certificate OR passport page
na na Evidence of visa (if available)
naProof of medical conditions and special learning needs (if applicable)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
8
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
Please keep a copy of this application for your own record and subsequent enquiry
1 Student Details
Family name
Given name
Date of birth D D M M Y Y Y Y Gender Male Female
Nationality on passport
Country of birth
In which country will you be applying for your visa
Passport number Expiry date D D M M Y Y Y Y
2 Contact Details
It is compulsory to complete these details
bull Please note a legal guardian in relation to a child refers to having the right to the daily care and control of the child and the right to make decisions for that child
bull Please include the contact details of the adults to contact with regard to the payment of all fees and in the event of any student emergencies
FatherrsquosLegal guardianrsquos family name
FatherrsquosLegal guardianrsquos given name
MotherrsquosLegal guardianrsquos family name
MotherrsquosLegal guardianrsquos given name
Family contact number (include country and area codes)
Family email address
Street Address
City StateProvince PostcodeZip
Country Phone (include country and area codes)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
6
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
3 Accommodation Details in Victoria
Please indicate who the student will live with Parent Relative or family friend
Family name Given name
Relationship to student
Street Address
City State Postcode
Phone Mobile
4 Sibling Details
Does the student have a brother or sister currently enrolled at a Victorian government school Yes No
If yes which school are they attending
Sibling name 1 Sibling student ID number
Sibling name 2 Sibling student ID number
Sibling name 3 Sibling student ID number
Sibling name 4 Sibling student ID number
5 Study Plan
Name of school GradeYear level
Commencement date D D M M Y Y Y Y End date D D M M Y Y Y Y
6 School Preferences
Please refer to wwwstudyvicgovau for a full list of Victorian government schools
The IED is able to offer enrolment based on the availability of places in a particular grade or year level in each school To assist in the placement of the student in a suitable school please provide a list of preferred schools and subjects
Preferred schoolsPreferred subjects (Year 11 students must complete this section)
bull bull EnglishEAL
bull bull
bull bull
bull bull
bull bull
7
7 Special Circumstances
The more information you provide will ensure that the student is placed in a school with the most appropriate support according to their needs
Has the student been diagnosed with a medical condition that a doctor should be aware of If so please provide details
Does the student have any special learning needs which the school needs to be aware of If so please provide details
8 Primary School Enrolment Immunisation Requirements
It is a legal requirement under Victoriarsquos Public Health and Wellbeing Act 2008 for parents to provide an immunisation status certificate to the primary school at the time of enrolment
For more information about how to obtain an immunisation status certificate please refer to the Department of Health website located at the following link httpswww2healthvicgovauApidownloadmedia7B5F1D6A9A-D91B-4FC1-AAF5-37A938B01AD27D~text=How20do20I20obtain20an20immunisation20status20certificate3Famptext=phone201800206532080920orChildhood20Immunisation20Register20(ACIR)
9 Checklist
The application process will not commence until the application form is complete and all necessary supporting documentation is provided to the IED of DET
Copies of the following original documents must be provided
bull in the original language
bull translated into English
bull certified as true copies of the original documents by an authorised person of the country concerned
Copy of original document
English translation
Certified as true copies of original
Document
na Birth certificate OR passport page
na na Evidence of visa (if available)
naProof of medical conditions and special learning needs (if applicable)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
8
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
3 Accommodation Details in Victoria
Please indicate who the student will live with Parent Relative or family friend
Family name Given name
Relationship to student
Street Address
City State Postcode
Phone Mobile
4 Sibling Details
Does the student have a brother or sister currently enrolled at a Victorian government school Yes No
If yes which school are they attending
Sibling name 1 Sibling student ID number
Sibling name 2 Sibling student ID number
Sibling name 3 Sibling student ID number
Sibling name 4 Sibling student ID number
5 Study Plan
Name of school GradeYear level
Commencement date D D M M Y Y Y Y End date D D M M Y Y Y Y
6 School Preferences
Please refer to wwwstudyvicgovau for a full list of Victorian government schools
The IED is able to offer enrolment based on the availability of places in a particular grade or year level in each school To assist in the placement of the student in a suitable school please provide a list of preferred schools and subjects
Preferred schoolsPreferred subjects (Year 11 students must complete this section)
bull bull EnglishEAL
bull bull
bull bull
bull bull
bull bull
7
7 Special Circumstances
The more information you provide will ensure that the student is placed in a school with the most appropriate support according to their needs
Has the student been diagnosed with a medical condition that a doctor should be aware of If so please provide details
Does the student have any special learning needs which the school needs to be aware of If so please provide details
8 Primary School Enrolment Immunisation Requirements
It is a legal requirement under Victoriarsquos Public Health and Wellbeing Act 2008 for parents to provide an immunisation status certificate to the primary school at the time of enrolment
For more information about how to obtain an immunisation status certificate please refer to the Department of Health website located at the following link httpswww2healthvicgovauApidownloadmedia7B5F1D6A9A-D91B-4FC1-AAF5-37A938B01AD27D~text=How20do20I20obtain20an20immunisation20status20certificate3Famptext=phone201800206532080920orChildhood20Immunisation20Register20(ACIR)
9 Checklist
The application process will not commence until the application form is complete and all necessary supporting documentation is provided to the IED of DET
Copies of the following original documents must be provided
bull in the original language
bull translated into English
bull certified as true copies of the original documents by an authorised person of the country concerned
Copy of original document
English translation
Certified as true copies of original
Document
na Birth certificate OR passport page
na na Evidence of visa (if available)
naProof of medical conditions and special learning needs (if applicable)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
8
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
7 Special Circumstances
The more information you provide will ensure that the student is placed in a school with the most appropriate support according to their needs
Has the student been diagnosed with a medical condition that a doctor should be aware of If so please provide details
Does the student have any special learning needs which the school needs to be aware of If so please provide details
8 Primary School Enrolment Immunisation Requirements
It is a legal requirement under Victoriarsquos Public Health and Wellbeing Act 2008 for parents to provide an immunisation status certificate to the primary school at the time of enrolment
For more information about how to obtain an immunisation status certificate please refer to the Department of Health website located at the following link httpswww2healthvicgovauApidownloadmedia7B5F1D6A9A-D91B-4FC1-AAF5-37A938B01AD27D~text=How20do20I20obtain20an20immunisation20status20certificate3Famptext=phone201800206532080920orChildhood20Immunisation20Register20(ACIR)
9 Checklist
The application process will not commence until the application form is complete and all necessary supporting documentation is provided to the IED of DET
Copies of the following original documents must be provided
bull in the original language
bull translated into English
bull certified as true copies of the original documents by an authorised person of the country concerned
Copy of original document
English translation
Certified as true copies of original
Document
na Birth certificate OR passport page
na na Evidence of visa (if available)
naProof of medical conditions and special learning needs (if applicable)
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
8
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
10 Preferred Correspondence
Please complete ONE of the following options
DET Accredited Education Agent Details
Company name Contact person
Visit httpswwwstudyvicgovauenbrochures-and-formsPagesBrochureFormsaspx for a list of DET accredited education agents
OR
Familyother (to be completed if not using a DET accredited education agent)
Name
Street address City
StateProvince PostcodeZip Country
Phone Mobile
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
9
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
11 Declaration and Agreement
This information MUST be provided otherwise there may be delays with the processing of the application
I the parent or Legal Guardian of the student nominated on this application form declare that
bull I have read (andor had explained to me) understand and accept the terms and conditions of enrolment in this application form
bull I have read (andor had explained to me) understand and accept key policies outlined in this application form
bull I understand that the application fee (and School Transfer fee if applicable) are not refundable
bull I understand that the refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy I understand that any refund of paid tuition and other fees are subject to the Department of Education and Trainingrsquos refund policy as amended from time to time
bull by signing this application form for your child to study in a Victorian government primary school you are agreeing to provide an immunisation status certificate to the primary school It is recommended that you provide the immunisation status certificate to the primary school following the completion of this application form and your arrival in Australia but before your child attends the primary school
bull the information provided in this application is correct and complete the relevant documents are attached and that the information in the attached documentation provided is true and correct
bull I understand that I must declare to the Department of Education and Training any disability or medical condition that the student may have
bull I understand that the Department of Education and Training has the right to reject this application
ParentrsquosLegal Guardianrsquos name ParentrsquosLegal Guardianrsquos SignatureDate D D M M Y Y Y Y
OR
I the DET accredited education agent (if agent representation has been appointed) representing the student nominated on this application form declare that
bull the information provided in this application is correct
bull the parent has read andor I have explained all the terms and conditions outlined in this application form
bull I have explained to the parent the conditions of the Department of Education and Trainingrsquos refund policy AND explained that the application fee and School Transfer fee are not refundable
bull I understand that the Department of Education and Training has the right to reject this application
Agentrsquos name Agentrsquos signature
Date D D M M Y Y Y Y
Please keep a copy of this application for your own record and subsequent enquiry
VICTORIAN GOVERNMENT SCHOOLS TEMPORARY INTERNATIONAL STUDENT APPLICATION
10
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
Notes
11
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021
- Check Box 22 Off
- Check Box 24 Off
- Check Box 23 Off
- Check Box 25 Off
- Text Field 23
- Text Field 24
- Text Field 25
- Text Field 26
- Text Field 28
- Text Field 29
- Text Field 30
- Text Field 31
- Text Field 32
- Text Field 33
- Text Field 34
- Text Field 35
- Text Field 36
- Text Field 39
- Text Field 40
- Text Field 37
- Text Field 38
- Text Field 27
- Text Field 1068
- Text Field 1069
- Text Field 1070
- Text Field 1071
- Text Field 1072
- Text Field 1073
- Text Field 1074
- Text Field 1075
- Text Field 1076
- Text Field 1077
- Text Field 1078
- Text Field 1079
- Text Field 1080
- Text Field 1081
- Text Field 1082
- Text Field 1083
- Check Box 26 Off
- Check Box 28 Off
- Check Box 30 Off
- Check Box 27 Off
- Check Box 29 Off
- Check Box 31 Off
- Check Box 32 Off
- Check Box 34 Off
- Check Box 33 Off
- Check Box 35 Off
- Text Field 42
- Text Field 44
- Text Field 45
- Text Field 46
- Text Field 49
- Text Field 51
- Text Field 52
- Text Field 53
- Text Field 57
- Text Field 54
- Text Field 58
- Text Field 55
- Text Field 59
- Text Field 56
- Text Field 61
- Text Field 90
- Text Field 98
- Text Field 91
- Text Field 99
- Text Field 92
- Text Field 100
- Text Field 93
- Text Field 101
- Text Field 94
- Text Field 102
- Text Field 95
- Text Field 103
- Text Field 96
- Text Field 104
- Text Field 97
- Text Field 105
- Text Field 62
- Text Field 63
- Text Field 67
- Text Field 110
- Text Field 64
- Text Field 68
- Text Field 65
- Text Field 69
- Text Field 66
- Text Field 70
- Text Field 60
- Text Field 50
- Text Field 47
- Text Field 48
- Text Field 43
- Check Box 36 Off
- Check Box 40 Off
- Check Box 42 Off
- Check Box 44 Off
- Check Box 38 Off
- Text Field 71
- Text Field 72
- Text Field 73
- Text Field 75
- Text Field 76
- Text Field 77
- Text Field 79
- Text Field 82
- Text Field 84
- Text Field 83
- Text Field 80
- Text Field 81
- Text Field 78
- Text Field 74
- Text Field 85
- Text Field 86
- Text Field 106
- Text Field 1014
- Text Field 107
- Text Field 1015
- Text Field 108
- Text Field 1016
- Text Field 109
- Text Field 1017
- Text Field 1010
- Text Field 1018
- Text Field 1011
- Text Field 1019
- Text Field 1012
- Text Field 1020
- Text Field 1013
- Text Field 1021