Application to Study Form

International
www.scei.edu.au

How to Complete this Form CRICOS Provider Number 02934D

RTO Provider Number 121952
Please write clearly in black ink using capital letters in English. ABN Number 56 121 182 027

Include one set of supporting documents with this application including certified English
translation copies where required.
All supporting documents for this application must be certified as true copies of originals.
Refer to the following https://immi.homeaffairs.gov.au/help-support/applying-online-or-on-paper/on-
paper/certified-copy for more details.
Ensure that you sign the declaration in the end of this form.
Please note that delays may occur in the processing of this application if the application is incomplete.

(A) COURSE DETAILS

Term (Intake) : Month Year : Campus : MEL ADL

Work
CRICOS
Select NTIS Code Course Title Duration Tuition Fee Placement Material Fee
Code
Fee

104035B BSB50820 Diploma of Project Management 52 WEEKS $12,000.00 N/A $350.00

104439D BSB60720 Advanced Diploma of Program Management 52 WEEKS $12,000.00 N/A $350.00

090551A CHC33015 Certificate III in Individual Support 44 WEEKS $6,000.00 N/A $250.00

090552M CHC43015 Certificate IV in Ageing Support 60 WEEKS $9,000.00 $250.00 $250.00

090557F CHC43115 Certificate IV in Disability 56 WEEKS $9,000.00 $250.00 $250.00

090553K CHC52015 Diploma of Community Services 104 WEEKS $20,000.00 $700.00 $350.00

090595M CHC62015 Advanced Diploma of Community Sector Management 66 WEEKS $10,000.00 $500.00 $350.00

108095B CHC30121 Certificate III in Early Childhood Education and Care 50 WEEKS $10,000.00 $250.00 $200.00

108094C CHC50121 Diploma of Early Childhood Education and Care 57 WEEKS $12,000.00 $250.00 $200.00

090550B HLT37215 Certificate III in Pathology Collection 32 WEEKS $7,000.00 $800.00 $500.00

090556G HLT52015 Diploma of Remedial Massage 77 WEEKS $12,000.00 N/A $500.00

108324E HLT54121 Diploma of Nursing 85 WEEKS $32,000.00 $5,500.00 $1,500.00**

Note : Application Fee $250 and Overseas Student Health Cover (OSHC) are not included in the Tuition fee.
** This indicates consumable fee for lab use

(B) PERSONAL DETAILS (AS SHOWN IN PASSPORT)

Title : Gender : Male Female Indeterminate/Intersex/Unspecified Rather not say

Given Name(s) : Last Name :

Date of Birth (dd/mm/yyyy): Country of Birth :

Nationality : First Language :

Passport Number : Expiry Date (dd/mm/yyyy) :

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 (C) CONTACT DETAILS

Address (Home Country) :

City : Country : Postcode :

Address (if in Australia) :

Suburb : State : Postcode :

Phone Number : Mobile :

Email Address :

(D) EMERGENCY CONTACT DETAILS

Name :

Number : Relationship : Postcode :

In Case of an Emergency: In the event of circumstances requiring urgent medical care where the student is incapable of speaking on their own behalf,
SCEI is authorised as a matter of urgency to seek and provide appropriate medical care on behalf of the student.

(E) DISABILITY SUPPORT

Do you consider yourself to have a disability, impairment of long-term condition? No Yes, please specify

If yes, please indicate the areas of disability, impairment or long-term condition: You may indicate more than one area

Hearing / Deaf Physical Intellectual Mental illness

Vision Medical condition Learning Acquired brain impairment

Other, please specify :

(F) LANGUAGE & CULTURAL DIVERSITY

Language and Cultural Diversity

Question Answer

Australia
In which country were you born?
Other, please specify

Do you speak a language other than English at home? No, English only
If more than one language, indicate the one that is spoken most often Yes, please specify:

Very Well Not Well

How well do you speak English?
Well Not at all

No
Are you Aboriginal or Torres Strait Islander origin?
Yes
For persons of both Aboriginal and Torres Strait Islander origin, mark both “Yes” boxes
Yes, Torres Strait Islander

(G) EDUCATION DETAILS

G.1 Schooling

What is your highest completed school level? (Tick one box only)
If you are currently enrolled in secondary education, the Highest school level completed refers to the highest school level you have actually
completed and not the level you are currently undertaking.

Year 12 Year 10 Year 8 or lower

Year 11 Year 9 or equivalent Never attended school

Year completed

Are you still attending secondary school? Yes No

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(G) EDUCATION DETAILS (cont.)

G.2 Previous qualifications achieved

Have you successfully completed any of these qualifications? Yes No

If yes, please provide details of your qualifications. Highest Level (Select one only)

Select Course A E I Note:

Bachelor Degree of Higher Degree If you have multiple Prior

Education Achievement
Advanced Diploma or Associate Degree Recognition Identifiers for
any other qualifications,
Diploma ( or Associate Diploma) use the following priority
order to determine which
Certificate IV (or Advanced Certificate/Technician) identifier to use:

Certificate III (or Trade Certificate) A - Australia

Certificate II E - Australia Equivalent

I - International
Certificate I

Certificates other than the above

If Yes, your Application must include a completed Credit Transfer Application

Do you wish to apply for Credit Transfer? No Yes Form available from the SCEI Website: www.scei.edu.au

If Yes, please download the RPL Policy and Application Form from the
Do you wish to apply for RPL? No Yes SCEI Website: www.scei.edu.au and contact us for your relevant RPL Kit.

Are you currently studying with another provider? No Yes If Yes, Date commenced (dd/mm/yyyy):

(H) ENGLISH PROFICIENCY

Please provide details of any English test / Course taken :

IELTS Academic PTE Academic OET TOEFL iBT

Reading Score Writing Score Speaking Score Listening Score Overall Score Date Achieved

ELICOS Course Name : Date Completed :

Other Please Specify :

(I) Barrier

Do you have any barriers that may prevent you from successfully completing your study?

Yes No (skip to the next step)

Learning difficulties Primary caregiver responsibilities Other, please specify:

Transport issues Ongoing regular appointments

Unstable housing Legal issues

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 (J) Diploma of Nursing Applicants ONLY

Please read the NMBA English language skills registration standard to assist you to understand the requirements and
then tick the box that applies to you:

Pathway 1: English is primary language.

English is your primary language and you have completed at least six years of primary and secondary education taught and assessed in English in any of the recognised
countries, and includes at least two years between grades 7 and 12.

Level of Program name Educational institution Recognised country

Timeframe Study status
education If applicable Specify name and address If applicable

Australia Canada
Study Primary
commenced: New Zealand Republic of Full time
Secondary
South Africa Ireland
Vocational
United Part time
Tertiary United States
Kingdom

Australia Canada
Study Primary
commenced: New Zealand Republic of Full time
Secondary
South Africa Ireland
Vocational
United Part time
Tertiary United States
Kingdom

Australia Canada
Study Primary
commenced: New Zealand Republic of Full time
Secondary
South Africa Ireland
Vocational
United Part time
Tertiary United States
Kingdom

Australia Canada
Study Primary
commenced: New Zealand Republic of Full time
Secondary
South Africa Ireland
Vocational
United Part time
Tertiary United States
Kingdom

Australia Canada
Study Primary
commenced: New Zealand Republic of Full time
Secondary
South Africa Ireland
Vocational
United Part time
Tertiary United States
Kingdom

Australia Canada
Study Primary
commenced: New Zealand Republic of Full time
Secondary
South Africa Ireland
Vocational
United Part time
Tertiary United States
Kingdom

I declare that English is my primary language as defined above and I meet the NMBA English language skills
registration standard requirements.

Name :

Signed: Date :

Pathway 2: English is not your primary language but you achieve the required minimum scores as specified in the
NMBA English language registration standard.

Were your results from In certain circumstances, you can use English language test results from a maximum of two test sittings in a six month period.
the English language For more information, refer to the NMBA’s English language skills registration standard.
tests obtained in one or
two sittings?
One sitting. Provide details for one sitting.
IELTS Academic PTE Academic OET TOEFL iBT
Two sitting. Provide details for both sittings.

Sittings Reading Score Writing Score Speaking Score Listening Score Overall Score Date Achieved

Sitting 1

Sitting 2

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NMBA English language skills registration standard Information:

All applicants who do not have English as their primary language need to provide English Language test score results showing:

a) an IELTS (academic module) with a minimum overall score of 7 and a minimum score of 7 in each of the four components (listening, reading, writing and speaking). OR

b) an OET with a minimum score of B in each of the four components (listening, reading, writing and speaking). OR

c) a PTE Academic with a minimum overall score of 65 and a minimum score of 65 in each of the four communicative skills (listening, reading, writing and speaking). OR

d) a TOEFL iBT with a minimum total score of 94 and the following minimum score in each section of the test:

• 24 for listening
• 24 for reading
• 27 for writing
• 23 for speaking

I declare that I have undertaken/I will undertake an approved English language test and achieve the minimum scores to
meet the NMBA English language skills registration standard requirements. I have/I will attach/provide my test results prior
commencing the course.

Name :

Signed: Date :

(K) STUDY REASON

Of the following categories, select the one which BEST describes the main reason you are undertaking this course/
traineeship/apprenticeship (Tick ONE box only)

To get a job I wanted extra skills for my job

To develop my existing business To get into another course of study

To start my own business For personal interest or self-development

To try for a different career Other reasons

To get a better job or promotion To get skills for community/voluntary work

It was a requirement of my job

(L) EMPLOYMENT

Of the following categories, which BEST describes your current employment status? (Select one only)

Full-time employee Employed – unpaid worker in a family business

Part-time employee Unemployed – seeking full-time work

Self employed – not employing others Unemployed – seeking part-time work

Self employed – employing others Not employed – not seeking employment

Which of the following classifications BEST describes your current or recent occupation? (Select one only)
If never employed go to next question.

1 – Managers 6 – Sales Workers

2 – Professionals 7 – Machinery Operators and Drivers

3 – Technicians and Trade Workers 8 – Labourers

4 – Community and PersonalService Workers 9 – Other

5 – Clerical and Administrative Workers

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 (M) EMPLOYMENT (cont.)

Which of the following classifications BEST describes the Industry of your current or previous Employer?
(Select one only)

Agriculture, Forestry and Fishing Financial and Insurance Services

Mining Rental, Hiring and Real Estate Services

Manufacturing Professional, Scientific and Technical Services

Electricity, Gas, Water and Waste Services Administrative and Support Services

Construction Public Administration and Safety

Wholesale Trade Education and Training

Retail Trade Health Care and Social Assistance

Accommodation and Food Services Arts and Creation Services

Transport, Postal and Warehousing Other Service

Information Media and Telecommunications

(N) UNIQUE STUDENT IDENTIFIER

Enter Unique Student identifier (if you already have one):

From 1 January 2015, we SCEI can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when
you complete your program if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI you can apply for it directly at
https://.usi.gov.au/your-usi/create-usi on a computer or mobile device. If you want SCEI to apply to the Student Identifiers Registrar on your behalf
for a USI, please complete and attach the Unique Student Identifier Application form.

(O) SURVEY CONTACT STATUS

Survey Contact Status is used to exclude clients from participating in the student Outcomes Survey and other communications
Of the following categories, which BEST describes your Survey Contact Status (Tick ONE box only)

Available for survey use Invalid address/Itinerant student (very low likelihood of response)

Correctional facility (address or enrolment) Minor - under age of 15 ( not to be surveyed)

Deceased student Overseas (address or enrolment)

Excluded

(Q) VISA DETAILS

Do you currently hold any type of Australian Visa?

Yes (provide details below) No

Visa Type : Subclass : Expiry Date (dd/mm/yyyy) :

What type of student visa application will you submit to Department of Home Affairs (DHA)?

Single Couple Family

DHA office where Application is lodged (or will be lodged)

Country : City :

Visa Application Date (Or intended if known) :

Have you ever or any other person involved in the visa application ever been convicted of a criminal offence?

No Yes (provide a statement to explain)

Have you ever or any other person involved in the visa application had any visa refused or cancelled in Australia or any other
countries before?

No Yes (provide a statement to explain)

ENROLMENT FORM
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 (P) OVERSEAS STUDENT HEALTH COVER (OSHC) DETAILS

Do you already have OSHC? If Yes then please provide details.

Provider’s Name : Type : Single Couple Family

Membership Number : Expiry Date (dd/mm/yyyy) :

Do you want SCEI to arrange OSHC for you? If yes then please provide details :
(Note: SCEI will arrange NIB OSHC only)

Type : Single Couple Family

(R) HOW DID YOU HEAR ABOUT SOUTHERN CROSS EDUCATION INSTUTE?

Agent Instagram / LinkedIn / Google+ Google Search

Events Newspaper / Magazine Radio

Exhibitions SCEI Student. Please provide ID:

Facebook SCEI Staff. Please provide name:

(S) AGENT DETAILS (If applying through an agent)

Company Name :

Agent’s Name :

Email Address : Contact Number :

I confirm that I have verified the above mentioned potential student’s application, supporting and financial documents and I am satisfied that this “Enrolment Form” contains the correct information. I have
assessed the applicant as a Genuine Temporary Entrant and Genuine. I am satisfied that the information and documentation provided is authentic and where the document has been stamped or translated
by the agency, the original document has been sighted and certified.

Agent’s / Representative Signature Agent’s Stamp

(T) PAYMENT PLAN OPTIONS (Conditions apply)

Prior to establishing a payment plan, please ensure your initial deposit has been made.
Please choose one preferred payment plan option :

Every Month Every 2 Months Every 3 Months Every 6 Months

(U) ENROLMENT PROCEDURE

1. Enrolment Procedure 2. Enrolment and Acceptance

Fill out the Application to Study Form provided by SCEI and SCEI enrolment officer will assess the application to study form and if accepted
send it through email to [email protected] OR Post to: successfully letter of offer will be issued through email within 5 working days.

a. Melbourne Campus b. Adelaide Campus 3. Payment of Fee

155-161 Boundary Road, 14 Grote Street, The application will accept the letter of offer and deposit fee in the nominated
North Melbourne, VIC, Adelaide, SA bank account of SCEI. SCEI will then issue Confirmation of Enrolment (CoE) and
Australia 3051, OR Australia 5000 send through email.

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 (V) ATTACHMENT CHECKLIST

Provide all the relevant documents, incomplete applications will cause delays in processing:

Certified evidence of English language proficiency like IELTS, TOEFL, PTE and ELICOS, etc.

Certified documented evidence of Year 12 education or equivalent (with certified translation, if not in English)

Certified documented evidence of other previous qualifications if applicable (with certified translation, if not in English)

Certified copy of Passport

Financial declaration form (if applicable)

Copy of Visa (if applicable)

Evidence of Overseas Health Cover (if applicable)

Copies of Confirmation of Enrolments (if applicable)

Certified copies of documents to be assessed for Credit Transfer and/or Recognition of Prior Learning (RPL) if required

Other

(W) DECLARATION AND AGREEMENT

In signing this Application Form, I agree that I have read and understood the following:

I declare that I have a genuine intention to study the course for which I have applied, and that I have access to sufficient
funds to cover tuition fees, living expenses, travel expenses, Overseas Student Health Cover for the duration of my studies
and to support my dependants (if coming along with me).

I understand that the application fee accompanying this application to study form is non-refundable.

I acknowledge that any false or misleading statement may result in denial of my admission application or subsequent
cancellation of my enrolment at SCEI, which may affect the validity of my visa.

The information on this form is true and correct. This information may be used for monitoring, program planning and
statistical purposes.

I declare that I will be solely responsible for meeting the conditions listed on my current student visa and liaise with DHA
and my agent (if applicable).

I declare that I have also read the ESOS framework provided by SCEI in Student’s Handbook.

I, have honestly and accurately completed this application form.

Student Signature: Date (dd/mm/yyyy) :

ADELAIDE
+61 8 8212 8745

14 - 16 Grote Street, Adelaide SA 5000

MELBOURNE

+61 3 9602 4110

www.scei.edu.au
155-161 Boundary Road, North Melbourne VIC 3051
CRICOS Provider Number 02934D
RTO Provider Number 121952 41 Boundary Road, North Melbourne VIC 3051
ABN Number 56 121 182 027

APPLICATION TO STUDY
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