Enrol – international student

I wish to study: *
My preferred starting date for this course is: *
2nd February 201520th April 201513th July 20156th October 2015
Are you currently enrolled in a course with another provider? *
YesNo
Please provide details about the course *
How many months of this course have you completed? *Enter the number of months, e.g. 6 months
Please note: The Health Institute Australia will not enrol a student prior to the student completing six months of his or her principal course except in certain circumstances as outlined under the STRO standards of the Health Institute Australia’s Student Manual.

Name * First Last
Email *
Date of birth *Enter month alphabetically e.g. 15 Jan 1970
Age *
Gender *
Country of birth *
Nationality *
Telephone Please include country & area code
Mobile *
Address (in home country) *
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Do you have an address in Australia?
YesNo
Your Address in Australia
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry

Name of highest qualification *
Name of Institution *
Year completed *
Certificate of highest qualification *Upload a copy of Certificate of your highest qualification
Academic transcripts Academic transcripts of last courses completed (if applicable)

Please include copies of additional certificates or other supporting documentation.
If you need to send more than 4 attachments, please email them to our office by replying to our confirmation email.
File Upload
File Upload
File Upload
File Upload

What do you plan to do when you have finished this course? *
Further studiesTravelReturn Home Other
Name of Institute/University Name of Institute or University if you are going on to further study
Course applied for

Immigration office - Country *DIBP (Australian Department of Immigration and Border Protection) office where you will apply for a student visa. Enter the country where the office is located.
Immigration office - City *Enter the city where the office is located.
Is English your first language? *
Is English the language you have grown up speaking since childhood?YesNo
IELTS Result *IELTS (International English Language Testing System) Result
Certificate of English test *Upload a CERTIFIED copy of your English test results
Type of visa *
Check the box for the Visa you currently have or will have upon traveling to AustraliaStudent VisitorWorkingBridging
Date your current visa expires (If applicable) Please enter the month alphabetically e.g. 15 Dec 2016
Copy of your current visa Upload copy of current visa (if applicable)

Are you under medical attention at the present time? *
YesNo
Does this entail any form of drug medication, psychiatric treatment, or is this for a nervous disorder? *
YesNo
Medical History
Please tick as many boxes as apply to youSkin conditionsRecent accident or injuryRecent fractureRecent surgeryArtificial jointSprains / strainsFeverSwollen glandsAllergies / sensitiviesHeart conditionHigh blood pressureLow blood pressureCirculatory disorderVaricose veinsEpilepsyHead-aches / migrainesCancerDiabetesBack / neck problemsPregnancyAsthmaJoint disorderOther
Medical Details
Please explain further
Do you have medical coverage for your stay in Australia? *
YesNo
Name of medical cover *
Membership Number *
Do you require Overseas Health Cover? *
YesNo
Level of cover required
Single Student 1 yearSingle Student 2 yearsSingle Student 3 yearsCouple/Family 1 yearCouple/Family 2 yearsCouple/Family 3 years Other

English Language Proficiency Level (evidence of your English language level is required)
Select English test *Please select one of the following English tests you have completed
Other test *Description of "Other" English language test you have taken
English language test score *Results of your English language test
File Upload *Upload a CERTIFIED copy of your English test results
English Language Level *
Indicate what level you feel you are atElementaryIntermediateUpper Intermediate
I wish to apply for the General English course *
See English Course for more details.YesNo
Enrol me in General English for: *
1 week (20 hours)4 weeks (20 hours per week)10 weeks (20 hours per week)
Upload any additional certificates for English language
Certificate Upload
Certificate Upload

Under or over 18 *
I am 18 years of age or olderI am under 18
Parent or Guardian consent *
The consent of a parent or guardian is required when you are under 18 years of agePlease email a consent form to my parent or guardianPlease post a consent form to my parent or guardian
Name of parent(s) or guardian(s) *
Parent or Guardian Email *
Parent or Guardian Address
(if different from your address)Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Terms and Conditions for international students *
I certify that the information provided on this form is true and correct, and I agree to abide by the terms and conditions of The Health Institute Australia Pty Ltd as outlined in the Terms & Conditions for International Students and the Local and International Student Manual, including the refund policy, of which I have read and understood.Yes, I agreeNo
Enrolment fee for accredited course *
I agree to pay the AUD$ 250 non-refundable enrolment fee (via Paypal, EFT, Mastercard or Visa)

Please only click the 'Submit Application' button once Once you have entered all the required fields, and you click the 'Submit Application' button below, there may be a delay while your data is processed. However, please only click the 'Submit Application' button once, and wait to be transferred to PayPal.