Expression of Interest Form

Version: 1.0 | Last Reviewed: February 2023

Campus Location:

Melbourne

Personal Details

Family/Last name: *

(as stated in your passport)

Given/First Name *

Nationality *

Date of Birth *

Student must be at least 18 years of age at the time of arrival in Australia

Country of Birth:

City of Birth:

Gender: *

Female

Male

Other

First Language:

Languages spoken at home:

Australian Residential Address (if known):

Street address
Suburb, locality, or town
State/Territory
Postcode

Address in Your Home Country: *

Address
Country
Telephone
Mobile
Fax
E-mail

Mailing Address in Australia (if different):

Street address
Suburb
State
Postcode
Telephone
Mobile
Fax
E-mail

Do you have any disabilities or medical conditions? *

Yes

If 'Yes', please specify:

Will it impact your ability to study?

Yes

Do you have a Unique Student Identifier (USI) number? *

Yes

USI Number:

No, please select:

I will create myself (please visit www.usi.gov.au)

I authorise UIA to create/retain/retrieve on my behalf (please fill USI consent form)

Passport and Visa Details

Passport Number: *

Expiry date: *

Country of citizenship: *

Are you currently in Australia? *

Yes

If yes, state your visa type:

Student

Spouse

Visitor

Other

Student visa subclass:

Other, please specify:

Do you have a valid Overseas Student HealthCover (OSHC)? *

Yes

Have you applied any Australian visa in the past? *

Yes

Have you applied for permanent residency in Australia? *

Yes

Have you had your visa refused in the past? *

Yes

Certified copy of your passport and visa copy if you have a visa:

Course of Study

Please select the course/s you are applying for to study at UIA:

Course Duration:

Course Commencement Date:

Reason for Choosing this Course

Please select the reason for choosing this course:

If other, please specify:

My referring agent / consultant is:

My UIA Representative:

Overseas Student Health Cover

Do you want UIA to organise your Overseas Student Health Cover? – this is a compulsory visa requirement

Yes

Part A – Insurer Details

Name of Insurer:
Member Number:
Date of Expiry:

Part B – Ultimate Institute of Australia (UIA) to arrange

Cover Type – Single: The length of your OSHC MUST cover the total length of your course(s)

Cover Type – Family: The length of your OSHC MUST cover the total length of your course(s)

1. The Australian Government requires all persons entering Australia on a Student Visa to have Overseas Student Health Cover (OSHC).

English Language Proficiency

Please select which of the following applies to you. Attach relevant evidences/ documentation to support your selections. *

English is my first language.

I have completed a recognised English language test.

I intend to complete an ELICOS course in Australia.

English was the language of instruction in my secondary/tertiary studies.

Other

Name of the test (e.g. IELTS, TOEFL):

Other

Evidence of English language skills test-for example, IELTS, PTE and TOEFL:

Please make sure you refer to the specific entry requirements that apply to the course you are applying for. These requirements are detailed in the student prospectus. From 1 July 2018, students applying for HLT54115 Diploma of Nursing, would be required by the NMBA to provide a formal English language skills test when applying for registration and must provide a formal English language test result demonstrating achievement of the NMBA specified level of English language skills, prior to commencing the program (www.nursingmidwiferyboard.gov.au).

Education History

Please provide details and documentation of your past education including the highest qualification reached or completed.

Year Completed
Name of School/Institution
State/Country
Name of Qualification
Course Duration

Please upload certified copies of your academic qualifications such as your results and award certificates:

Employment History

Please provide details and documents of your relevant employment. Attach a separate page if necessary.

Date Employed
Name & Country of Employer
Position
Duties

Employment-related documents such as employment letter and resume (where applicable):

Requests and Preferences

Do you want UIA to organise your accommodation?

Yes

If yes, what type of accommodation do you need?

Homestay

Sharing with others

Apartments, units and flats

Would you like UIA to provide you an airport pick-up?

Yes

Please indicate your preferred timetable choices for classes:

Weekdays

Weekends

(This Time-table choice is not guaranteed. UIA will do their best to meet this request):

Additional documents

Please attach a statement of purpose highlighting your grades, experiences and achievements:

Please attach any additional documents as required:

Media Consent

From time to time, UIA staff may request to take photographs/videos or verbal/written interviews/testimonials of students at UIA or at places where the student is involved in an activity. These creations may be used in a classroom or on-the-job work activities or could be published by UIA in print, digital or broadcast media such as documents, student magazine, website, UIA TV, newsletters, displays, journals, professional development materials for trainers and marketing collateral. Staff may also at times request students provide any of the above of the students’ own creation for the same purposes.

Media Consent: *

I do consent to UIA using any of the above materials involving me for the purposes outlined above.

I do not consent to UIA using any of the above materials involving me for the purposes outlined above.

Student Declaration

I confirm that I have read and understood UIA’s current Student Prospectus or information provided on UIA website (www.uia.edu.au) which details information about the ESOS framework, course entry requirements, English entry requirements, LLN requirements. I also understand fees payments and refund policy, including an explanation of what occurs, if for some unforeseen reason, the course is not delivered.
I confirm that I am fully aware of the fees and refund policy, conditions of enrolment and privacy statement as set out in Privacy Policy and Procedure, available at www.uia.edu.au/policies, which I agree to abide by as a student at UIA.
I understand that I am not required to pay more than the initial tuition fee amount as stated on this offer letter (or 50% of the tuition fee) before the start of the course.
However, I am also aware that I have a choice to pay more than 50% of the tuition fees or the full course fees upfront if I choose to do so. Any amount of fees paid before the start of the course will be reflected in my Confirmation of Enrolment (CoE).
I declare that all information provided in this expression of interest is complete and correct. I understand that failure to provide correct information or documentation in relation to this expression of interest may result in cancellation of my enrolment.

Signature of Student: *

Clear

*Note: This expression of interest and declaration must be signed by a parent or legal guardian if the student is under 18 years of age at the time of expression of interest. Student must be at least 18 years of age at the time of arrival in Australia.

Signature of Parent or Legal guardian:

Clear

Sign Date: *