diversity pathways application form - anu college · 2019-11-06 · advice received from other...

Tell us about yourself… Your personal details Family name Given name(s) Title Date of birth (dd/mm/yyyy) Age Gender Female Male Indeterminate/Intersex/Unspecified Residential address Street address

Suburb/Town/City State/Province Country Post/Zip code

Postal address (if different to residential address) Street address


Home phone (incl. country code) Mobile phone (incl. country code) Email address Previous ANU College ID Previous ANU ID

Your parent/guardian/alternative contact person’s details Family name Given name(s) Title Date of birth (dd/mm/yyyy) Relationship to you Residential address Street address


Home phone (incl. country code) Mobile phone (incl. country code) Email address

If you would like to authorise ANU to disclose details of your application to the parent/guardian/alternative contact person listed above, or another person, please complete and attach to your application the form Consent to the Disclosure of Personal Information available at www.anu.edu.au/files/resource/Consent-form.pdf

Diversity pathways Application form

1 | T H E A U S T R A L I A N N A T I O N A L U N I V E R S I T Y & A N U C O L L E G E

The Australian National University. CRICOS Provider Code: 00120C. ABN: 52 234 063 906 Study Group Australia Pty Limited trading as ANU College. CRICOS Provider Code: 01682E. ABN: 88 070 919 327

http://www.anu.edu.au/files/resource/Consent-form.pdf

Your citizenship, passport, ATSI and visa details As well as providing the details below, attach evidence of your citizenship, such as a copy of your passport.

Your citizenship Your second citizenship Your country of birth Your passport number Expiry date (mm/yyyy) Are you a Permanent Resident of Australia? Yes No Are you a holder of an Australian Humanitarian Visa? Yes No Are you an Australian Aboriginal or Torres Strait Islander? Yes No Do you currently hold, or have you had an Australian Visa in the past 6 months? Yes No Visa type (if applicable) Subclass Expiry date Do you have family members currently residing in Australia? Yes No

If yes, in which town/city do they reside? Do you currently hold an OSHC policy? Yes No

Name of OSHC provider Member number Expiry date

Have you applied for an Australian visa? Yes No Have you breached any visa conditions in any country? Yes No Have you had a visa refused for Australia or any other country? Yes No

If yes, attach a copy of the formal visa refusal notification along with a statement from you regarding the circumstances of the refusal.

Have you been convicted of any crime or offence in any country? Yes No If yes, provide details including offence type and location:

Your English language proficiency All students must demonstrate an acceptable level of English language proficiency to be admitted to ANU College and ANU. Provide details of your most recent tests below and attach results from ALL tests undertaken in the last two years.

Test name Overall/Total Test Date (e.g. IELTS, TOEFL) Listening Speaking

Reading Writing

Test name Overall/Total Test Date (e.g. IELTS, TOEFL) Listening Speaking

Reading Writing

Adjustment and inclusion Do you have a disability, impairment or long-term medical condition which may affect your studies? No Acquired brain impairment Hearing Intellectual Learning Physical Medical condition Mental illness Mobility Vision

Funding How do you intend to fund your studies? Self-funded Scholarship (provide scholarship name) Family-funded Sponsorship (provide sponsorship name)



Your previous education Provide details of all secondary (e.g. high school) and tertiary (e.g. university or polytechnic) studies attempted. You need provide documentation for all of your studies – see Documentation requirements below for details.

Qualification level (e.g. senior secondary, postgraduate) Qualification name State/Country Institution Language(s) of instruction Language(s) of assessment Attended from (mm/yyyy) Attended to (mm/yyyy or current) Completed? Yes No Did the qualification include a significant research component? Yes No

If yes, length in words or months of study?





Have you ever been excluded, or are you facing exclusion, from study on academic or other grounds?

Yes No

If yes, provide details including the date and duration of the exclusion:



Tell us about your pathway to ANU… Pathway program Select the ANU College program or ANU Diploma you wish to study as a pathway to an ANU degree. You may select Academic English Preparation 4 as well as Access English, Foundation or an ANU Diploma.

Academic English Preparation 3 (AEP3) – IELTS Overall 5.0 with no band less than 4.5, or equivalent 20 January 2020 14 April 2020 20 July 2020 12 October 2020

Academic English Preparation 4 (AEP4) – IELTS Overall 5.5 with no band less than 5.0, or equivalent 20 January 2020 14 April 2020 20 July 2020 12 October 2020

Access English – IELTS Overall 6.0 with no band less than 5.5, or equivalent 2 December 2019 14 April 2020 9 November 2020 12 April 2021

ANU College Foundation Standard 13 January 2020 13 July 2020 11 January 2021

ANU College Foundation Rapid 6 April 2020 6 October 2020 6 April 2021

ANU College Foundation Extended 11 November 2019 18 May 2020 16 November 2020

Diploma of Computing – pathway to Bachelor of Information Technology 24 February 2020 27 July 2020 22 February 2021 26 July 2021 21 February 2022

Diploma of Creative Design – pathway to Bachelor of Design 24 February 2020 27 July 2020 22 February 2021 26 July 2021 21 February 2022

Diploma of Liberal Studies – pathway to Bachelor of Arts 24 February 2020 27 July 2020 22 February 2021 26 July 2021 21 February 2022

Diploma of Music – pathway to Bachelor of Music 24 February 2020 22 February 2021 21 February 2022

Diploma of Science – pathway to Bachelor of Science 24 February 2020 22 February 2021 21 February 2022

ANU Degree Program Select the ANU degree program you wish to study following your ANU College program. • You may select only one degree. You will be contacted to discuss further options if you are not eligible for your

selected degree but you are eligible for another degree. If you have selected an ANU Diploma as your pathway program, the ANU degree program for which it is a pathway is listed above and you may skip this section.

ANU degree First Semester Second Semester

Do you have professional experience related to your selected ANU degree? Yes No If yes, provide brief details below and attach a copy of your résumé:



Applicant Declaration To apply to ANU College and ANU, you must make the following declaration:

1. I confirm that the documents presented as part of my application are a true and complete representation of mystudy history. I understand that it is an offence to submit fraudulent documentation in support of an applicationto The Australian National University (ANU) and/or Study Group Australia Pty Limited trading as ANU College(ANU College).

2. In the case that I have submitted incorrect, incomplete or fraudulent information, I understand that ANU and/orANU College will revoke my offer. If I am admitted or enrolled, I will be subject to relevant Statutes, Rules,Orders, Codes, policies, procedures and guidelines of ANU and/or the policies, procedures and guidelines ofStudy Group Australia and ANU College whereby, if I am found to have engaged in misconduct by providingincorrect, incomplete or fraudulent information, ANU and/or ANU College may vary or cancel my enrolment andany ANU scholarship(s), as prescribed. This may result in my application being denied and/or cancelled, andany enrolment terminated, and I may be referred to government and statutory authorities.

3. I understand that in some cases ANU and ANU College make decisions based on the information provided byrelevant third parties such as referees, sponsors, external scholarship providers, registered partners, and onadvice received from other relevant institutions. I understand that ANU and ANU College have the right to varyor cancel an application or enrolment (including any scholarship(s)) if ANU or ANU College subsequently findthat such information or advice is incorrect or untrue or misleading or fraudulent.

4. I acknowledge and agree to provide original documents if requested by ANU and/or ANU College.

5. I acknowledge and agree that all documents provided for my admission become the property of ANU and ANUCollege and will not be returned except at the discretion of ANU and/or ANU College.

6. I acknowledge and agree to ANU and/or ANU College auditing information presented for my admission,including but not limited to qualifications, English language proficiency and referee reports, and that thisincludes obtaining official records from institutions or issuing bodies for the purpose of verification of mysupporting documents.

7. I acknowledge and agree to ANU and/or ANU College providing my personal information to any relevant thirdparty for auditing and verification purposes, consistent with the ANU Privacy Policy or ANU College SGAStudent Privacy Policy, as applicable.

8. I declare that I am a Genuine Student and Genuine Temporary Entrant and that I have read and understood theconditions in relation to these requirements as defined on the Genuine Temporary Entrant requirement page onthe Australian Government website. I understand that if ANU and/or ANU College form the opinion that I am nota Genuine Temporary Entrant or a Genuine Student or I do not meet the Genuine Temporary Entrant andGenuine Student requirements set by Department of Home Affairs and/or I am unable to obtain or maintain astudent visa, ANU and/or ANU College may: refuse to assess my application; withdraw an offer of admissionand/or; cancel my enrolment.

9. I authorise ANU and ANU College to check my visa and residency status using the Australian Government’sVisa Entitlement Verification Online (VEVO) tool.

10. I understand that if my application is made in relation to, or subsequently becomes related to, an ANU-approved external scholarship/sponsorship provider or an ANU Strategic Partnership, my acceptance to ANUmay be conditional on being awarded the scholarship/sponsorship or conditions specified under the terms ofthe ANU Strategic Partnership agreement.

Your name Your signature Date:

If you are under 18 years of age, this declaration must also be signed on your behalf by a parent/guardian or a person/authority who has legal responsibility for you.

Parent/guardian’s name Parent/guardian’s signature Date:



Applicant Declaration (continued)

11. I understand that ANU and ANU College are bound by the Privacy Act 1988 of the Commonwealth of Australia,and that ANU and ANU College collect and use any personal information provided in accordance with the Act.

12. I authorise ANU and ANU College to share and exchange personal and academic information about me for theduration of my enrolment in any program administered by either entity, and later as an alumni of ANU ifapplicable.

13. I understand that if I am a sponsored student, the personal information collected by ANU and ANU College,including academic progress, results, attendance or financial standing, may be disclosed to my sponsor, myembassy, cultural mission or any third party appointed by my sponsor, my embassy and/or cultural mission.

14. I understand that ANU and ANU College are required under Section 19 of the ESOS Act 2000, to inform theDepartment of Home Affairs about changes to my enrolment and any breach of my student visa conditionsrelating to satisfactory academic performance. I also understand that under the provisions of the ESOS Act2000, ANU and ANU College may release information provided in this application to Australian Commonwealthand State agencies, including the Tuition Protection Service.

15. I authorise ANU and ANU College to collect, receive, store, transfer and use all such information; and allinformation in or connected with this application for training and/or research purposes. I give these authoritieson the condition that all information provided pursuant to training and/or research purposes is de-identified.

16. I understand that the type of information and the use and disclosure of that information by ANU College withoutany prior approval is set out in the SGA Student Privacy Policy, which can be found athttps://anucollege.edu.au.

17. I have read the SGA Student Privacy Policy and consent to the use and disclosure of my personal informationas set out in the Policy.

18. I understand that ANU collects, retains, uses and discloses personal information about me to enable ANU tomeet its operational requirements to me and its legal obligations, as detailed in the ANU Privacy Policy:https://policies.anu.edu.au/ppl/document/ANUP_010007

19. I have read the ANU Privacy Policy and consent to the collection, retention, use and disclosure of my personalinformation as set out in the Policy.

Your name Your signature Date:

If you are under 18 years of age, this declaration must also be signed on your behalf by a parent/guardian or a person/authority who has legal responsibility for you.

Parent/guardian’s name Parent/guardian’s signature Date:

Recruiting agent’s details

Agency Branch Agent ID Email Name Signature



https://anucollege.edu.au/

https://policies.anu.edu.au/ppl/document/ANUP_010007

Documentation requirements Evidence of previous education • For each academic qualification you have attempted, you need to provide an academic transcript. You should

also provide the institution’s grading system, if available. • For each academic qualification you have completed, you need to provide an academic transcript and a

completion/graduation/degree certificate or testamur. If you were issued a degree certificate and a graduation certificate, provide both. You should also provide the institution’s grading system, if available.

Evidence of English language proficiency • For English language test results, you need to provide an official test report certificate. Usually, this will include

a photo of you. A summary/confirmation email containing your scores will not be sufficient as evidence. • For previous studies taught and assessed in English, you need to provide a formal statement from the

institution, duly signed, and specifying your name, the name of the qualification and a statement confirming that the qualification was both taught and assessed entirely in English.

Translation into English If an original document is in a language other than in English, you need to provide an English translation along with the original. The translation must be provided by: • a translator accredited by National Accreditation Authority for Translators & Interpreters (NAATI);• the Community Relations Commission for Multicultural New South Wales;• the Interstate office of either the Ethnic Affairs Commission or the Department of Home Affairs;• an Australian diplomatic mission or;• a national government or other nationally-recognised translation authority.

Document format Documents can be scanned and attached to this application (electronically or hardcopy) in their full original colour. Photographs cannot be accepted. Documents may be sent by your institution to [email protected] or to:

ANU Pathway Admissions Di Riddell Building 154 The Australian National University Acton ACT 2601 Australia

Submission checklist

All sections of the application form have been completed Your personal details and parent/guardian/alternative contact person’s details Your citizenship, passport, ATSI and visa details Your English language proficiency Adjustment and inclusion Funding Your previous education Your selected Pathway program and ANU degree program

Attached evidence of citizenship (e.g. passport, birth certificate) Attached previous visa refusal and statement of circumstances (if applicable) Attached evidence of English language proficiency is attached Attached colour copies of academic transcripts and graduation certificates/testamurs for all previous qualifications Attached English translations of non-English academic transcripts and graduation certificates/testamurs Attached a copy of your résumé, if required Application Declaration signed by you (and your parent/guardian if you are under 18 years old)

Submitting your application Simply send a complete, signed copy of your application and all attachments by email to [email protected]



mailto:[email protected]

mailto:[email protected]