Application Form
PERSONAL DETAILS

*Title

* First Name

Last Name

Preferred Name

* Date of Birth (dd-mm-yyyy)

* Mobile

* Email

Email(Alternative)

Other / Middle Name

Home Phone

Work Phone

Gender

Have you got your concession card?

*Student Type?

Passport

Do you hold a current Australian Visa ?

Please Provide Code & Category of Visa

PERMANENT ADDRESS(RESIDENTIAL ADDRESS)

Building/Property Name

Flat/Unit Number

Street Number

Street Name

Suburb / City

State/Territory

Country

Zip / Postal Code

MAILING ADDRESS(POSTAL ADDRESS)

Copy permenent address to mailing address

Building/Property Name

Flat/Unit Number

Street Number

Street Name

Suburb / City

State/Territory

Country

Zip / Postal Code

PO box or roadside delivery box

E-mail address

COURSE DETAILS

*Course

Campus

Course Delivery Mode

Course Start Date

UNIQUE STUDENT IDENTIFIER (USI)

USI Status

Personal Identification Details

NEXT OF KIN

Full Name

Telephone

Relationship

Mobile

Address

Email

DISABILITY

*Do you consider yourself to have a disability?

*Disablility

LANGUAGE AND CULTURAL DIVERSITY

*Country you were born

Year of Arrival

*Type of Visa

*Current Residential Status

*Do you speak any other languages other than English at home ?

*Other languages

*English Speaking Ability

* Aboriginal or Torres Strait Islander origin?

English Test

Test Type

Overall Score Achieved:

Overall
Reading
Writing
Speaking
Listening
SCHOOLING

*Highest Completed School Level

*School level Completion Year

Still attending secondary school

PREVIOUS QUALIFICATIONS ACHIEVED

Have you SUCCESSFULLY completed any of the qualifications listed in question 15?

*Name of Program/Qualification

*Qualification Type

*Start Date

*Completion Date

*Qualification Year

*Institution

*Country

*Language of Instruction


EMPLOYMENT

*Employment Status

*Current Occupation

*Industry of your current or previous Employer?

*Study Reason

ABOUT IHNA

How did you hear about IHNA?

Please Specify

STUDENT SERVICES

Do you require Overseas Student Health Cover?

Health Cover Type

Duration

Airport Pickup-up: Do you require airport pick-up?

Accommodation: Do you require assistance with accommodation?

AUSTRALIAN STUDY

Have you previously studied in Australia?

Please Specify

Are you currently studying in Australia?

Please indicate name of institution

Name of program

Do you intend to complete?

Are you applying for Credit Transfer/RPL Application Form?

PAYMENT OPTIONS

Payment Plans

Payment Method

Expiry Date

CONSENT
I consent to receive marketing materials such as emails from IHNA for the purpose of notifying me of IHNA 's offers for other courses etc.
I have read and understood the Student Handbook and the Course Brochure (available at www.ihna.edu.au).
I have read and understood the Privacy Policy.
I have read and understood the USI Privacy Notice and Policy.
I have read and understood the Declaration.
Feedback

Can you suggest any improvements to our pre-enrolment information, application/enrolment process?