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-Elicos申請者に必要な情報

Tuesday 8 April 2025

Information Needed For ELICOS Applicants

- 英語で情報を入力してください

あなたの年齢が 18 歳未満の場合は、保護者がこのフォームに記入する必要があります。

Form #200

Personal Information

Title

Given Names

Middle Name (if Applicable)

Family Name

Country of Passport

Telephone

Email

Date of Birth

Gender

Country of Birth

Marital Status

Passport details

Passport Number

Place of Issue / Issuing authority

Date of Issue

Date of Expiry

Country of Passport

Nationality of Passport Holder

It is strongly recommended that the passport be valid for at least six months

Australian Address (if applicable)

Full Address

Postcode

City

Telephone

Email

Home Country Address

Full Address

Postcode

City

Country

Application Objective

Application ObjectiveIntended Degree/Course:

Field of Research/Study Focus:

Statement of Objectives (briefly state your goals):

Education Background

Start with the last Degree Earned

Select Your Latest Academic Qualification

Select the Area you Studied in

Select the Country of your Qualification

Name of Institution

Name of the Course

Date From

Date To

Type your GPA achieved

Please provide the average grade or score you received in your studies, known as your GPA (Grade Point Average). This number shows how well you have performed overall in your courses.

Course Duration

.

+ Attach Qualifications Scan (optional)

Employment Background

Do you have any work experience?

Yes

No

please provide details about your work experience

What is the name of the company or organization you worked for?

Major Group

From

To

Describe your primary responsibilities and duties in this role

+ Attach Employment Background Scan (optional)

Is this the application's current employment situation?

Yes

No

Technical Skills

List relevant technical skills:

Awards & Grants (if applicable)

List awards/grants received:

Professional Memberships (if applicable)

List memberships:

References

ReferencePosition:

Institution:

Phone:

Email:

Personal & Family Information

Personal & Family InformationFather’s Name:

Occupation:

Highest level of education of parent/guardian 1:

Mother’s Name:

Occupation:

Highest level of education of parent/guardian 2:

Disability

Do you consider yourself to have a disability, impairment or a long-term health condition?

Yes

No

Travel History

Travel HistoryCountry Visited:

Date Entered: DD/MM/YYYY

Date Departed: DD/MM/YYYY

Visa & Compliance History Australia

Have you ever been granted an Australian visa?

Yes

No

If you currently have one of the types of Australian visas, complete this section.

Do you currently hold a valid Australian visa?

Yes

No

Visa Type

Visa

Visa Grant Number

Visa Expiry Date

Please confirm the date you arrived in australia for the first time. (if applicable)

Have you ever been refused an Australian visa?

Yes

No

+ Attach Visa Scan (optional)

Visa & Compliance History Other Countries

Visa & Compliance HistoryPrevious Visa Refusals (if any to any country):

Compliance Issues (if any in any country):

Emergency Contact

Title

Given Names

Family Name

Please Describe Relationship to the Student

Telephone

Email

Full Address

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