Enrolment Form

Personal Details

Family name: *

Given names: *

Date of birth: *

Sex: *

Male

Female

Nationality: *

Type of visa:

Student

Tourist

Working holiday

Other

Other:

Passport number:

Contact Details

Current home address: *

City: *

State/province: *

Zip/postal code: *

Country: *

Phone: *

Email address: *

Course Details

Full time/part time:

Re-enrolled student/course extension

Full time student

Part time (not available for student visa)

Student number:

Course applying for:

General English

High School Preparation

IELTS Preparation

English for Academic Purposes

Cambridge First Certificate in English

English for Business Communication (EBC)

Other

Adult classes meet for 23 hours 20 minutes per week. HSP meets for an average of 23 hours 45 minutes per week.

Other:

Number of weeks:

Start date:

Agent name:

Additional Courses

For students wishing to study more than one course

Course 2

Name of course:

Number of weeks:

Start date:

Course 3

Name of course:

Number of weeks:

Start date:

Further Studies

Do you wish to do further studies in Australia?:

Yes

If yes please specify:

If you are studying High School Preparation, do you intend to enrol at a:

Private High School

Public High School

Undecided

If you are studying High School Preparation, which High School would you like to attend?:

Services

Do you require homestay arrangements?:

Yes

If Yes, please fill out the seperate Homestay Form

Airport Pick Up

Do you require airport pick up?:

Yes

Flight arrival date:

Flight arrival time (am/pm):

Flight number:

Airport Drop Off

Do you require airport pick up?:

Yes

Flight arrival date:

Flight arrival time (am/pm):

Flight number:

Medical Information

I authorise Milton College to seek assistance, on my behalf, should a medical emergency arise while I am in attendance at the college

Do you require Overseas Students Health Cover (Compulsory for Student visas only):

Yes

If Yes, please select:

Single cover

Family cover

Number of months of cover required:

Do you have allergies or other medical conditions?:

Yes

If so, please explain:

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