Postgraduate
International Student Application for Admission to Postgraduate Coursework Programs
Read this application carefully, complete all sections and ensure that supporting (certified) documents are attached. A non-refundable application fee of A$80 (by bank draft, credit card or bank cheque, payable to la Trobe university) must be attached to this application. If you wish to pay by credit card, please provide your details below. Please write in blOCk letters using a blue or black pen. Credit Card Details I want to pay my application fee by credit card Card number Cardholder Name Personal Details have you been previously enrolled at la Trobe university? yes Family Name given Name(s) date of birth (dd/mm/yy) Citizenship Are you a permanent resident of Australia? Student Contact Details (compulsory) Number and street suburb / Town / Country Postcode / Zipcode Telephone Agent Contact Details (if applicable) Agent Name Number and street suburb / Town / Country Postcode / Zipcode Telephone Course Preferences list the course/s in order of preference that you would like to study at la Trobe university Preference Name of course Majoring in (e.g. Accounting) Campus* Commencing Mth/year
(e.g.Feb/11)
yes
No
Card type – Mastercard Expiry date (mm/yy) Cardholder signature No
visa
If yes please provide your student number: Title (Mrs, Miss, Ms, Mr, dr, etc.) sex M or F
Country of birth Country (where you were living when you filled out this form) yes No
Email Mobile
Email Facsimile
Annual Tuition Fee A$
1 2 3
M M M
bE bE bE
A-w A-w A-w
s s s
MIl MIl MIl
C C C
Please note depending on demand and availability you may be offered a place at a different campus. Places will be allocated as soon as offer acceptance is received. * Campus: A-w = Albury-wodonga, M = Melbourne, bE = bendigo, s = shepparton, MIl = Mildura, C = Melbourne (City)
Students are able to change their course once only without being charged a fee. Any...