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Thank you for choosing to study at UEC.

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Name*
Title First name Last name
Gender*
- Male
- Female
Date of Birth:*
Date Format: DD slash MM slash YYYY
Country of Birth:*
Nationality*
Passport Number
Are you currently in Australia?*
- Yes
- No
If you are currently in Australia which visa do you have*
Type of visa you will be applying to study at UEC*
Your contact details*
Street Address Street Address (continued) City State/Region Postal Code Country
Telephone
Mobile
Email*
Email address Confirm email
Name of Emergency Contact (Carer details for under 18 student)*
Relationship to you*
Example: Mother, Father, Wife, Husband
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*

Do you require UEC to arrange airport transfers for you?*
- Yes
- No
If yes,*
- One way
- Return
Please provide your flight details at least 2 weeks before arrival.
Do you require homestay?*
- Yes
- No
For how many weeks?*
Do you require Student Residence*
- Yes
- No
Only available for students over 18 years of age.
Please select the type of room*
For how many weeks?*

Are you over 18 years
- Yes
- No
Have you read and understood the Terms and Conditions of Enrolment?*
- Yes
- No
Terms and Conditions of Enrolment
Are you applying through an education agency?*
- Yes
- No
Name of Agency as authorised by UEC*
Name of Counsellor*
Prefix First Last
Email address of Counsellor*
Addtional information or comments
Student Declaration*
I declare all the information provided in this application form is correct and that I have read, understood and accept Terms and Conditions of Enrolment which includes the Refund Policy and Indemnity Declaration.
I agree
Name
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