WIC – Application Form Agent - WIC - Application Form WIC - Application Form PART A: PERSONAL DETAILSUSITitle Mr. Ms. Mrs. Gender Male Female First NameLast nameDate DD slash MM slash YYYY NationalityPassport NoDo you currently hold a student visa ? Yes No Have your visa been cancelled/refused before? Yes No No. of Dependants:less than 5less than 10less than 15More than 15Main language spoken at homeHow well do you speak English: Very well Well Not well Not at all Are you of Aboriginal or Torres Strait Islander origin?PART B: CONTACT DETAILSAustrial Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Phone NumberEmail Address (Mandatory)*Overseas Address (Must be applicant’s address):PostcodeCountryPhone NumberEmergency Contact NameRelationshipMobile NumberEmail AddressPART C: EDUCATION & EXPERIENCEDo you intend to claim recognition of prior learning towards this course? Yes No Have you enrolled in a similar course elsewhere? Yes No Have you been employed in the area covered by thecourse applied for ? Yes No Have you ever completed the following English test? Yes No Test nameYear of testScorePART D: COURSE SELECTIONIT COURSE Select BUSINESS COURSE BSB42015 Certificate IV in Leadership and Management BSB51915 Diploma of Leadership and Management BSB61015 Advanced Diploma of Leadership and Management HOSPITALITY COURSE SIT30616 Certificate III in Hospitality SIT40416 Certificate IV in Hospitality SIT50416 Diploma of Hospitality Management SIT60316 Advanced Diploma of Hospitality Management Preferred Starting Date:Select Intake DateOther MM slash DD slash YYYY 2017 Intakes 09 January 03 April 03 July 25 September 2018 Intakes 08 January 03 April 02 July 24 September 2019 Intakes 07 January 01 April 01 July 23 September 2020 Intakes 06 January 30 March 29 June 21 September PART E: ADDITIONAL INFORMATIONTell us the reason you want to take our course: Career Academic Personal Where did you hear about us? Agents Advertising Word of mouth Do you have any disabilities that will effect your learning? Yes No SpecifyNote: 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 handbook. All courses require applicants 18 years and above and proficiency in English equivalent to the level of IELTS 5.5 or higher.PART F: PAYMENT DETAILSUntitled Enrolment Fee AU$ 200 COE Issue Fee AU$ 50 Materials Fee ($50/term) AU$ 50 Homestay AU$ 200 Replacement(Fee (Optiona) AU$ 250 (Full board) AU$ 180 (Share board) Airport Pick-up Fee (Optional) AU$ 150 Overseas Student Health Cover (OSHC) AU$ 255 (6 months) AU$ 510 (12 months) AU$ 1020 (24 months) Payment should be forwarded by bank transfer to the following: Bank: Commwealth Bank Account Name: Wells International College BSB: 062 016 Account Number: 1072 8104 Bank SWIFT Code: CTBAAU2S Reference: Your Name & Student Number Tuition fees must otherwise be paid in the form of a bank draft or bank cheque made payable to “Wells International College” only. Wells International College is not responsible for any tuition fee paid to a third party’s bank account. All payments must be made to an authorised education agent or directly to our bank accountPART G: APPLICANTS CHECKLISTPlease attach the following documents to this application Certified copy of your passport page Certified copies of your official final high school certificate and transcript Certified copies of your official college or university certificate and transcript Certified copies of your IELTS or any relavant English certificate Copy of your current visa (if applicable) Certified translations of any documents that are not in English PART H: DECLARATIONStudent Declaration I have read and accept the conditions of enrollment including the cancellation and refund policy of the institute as stated above. I declare that the information provided by me on this form is true and correct.Applicant Name:Applicant's SignatureDate DD slash MM slash YYYY REFERRAL / EDUCATIONAL AGENCY INFORMATIONAgency NameSelectStuneTWe Relocate YouOpen For AustraliaMUV-UAustralia Group2be study2U Study Pty Ltd360 Degree Agency7Mundos IntercambioA&F AssociatesABC Australia Education ConsultancyAC Australian CentreAFI Consultants (SMC -PRIVATE) LimitedAftab SyedAgency 123Agency HubAI Academia de Intercambio e TurismoAI FILMSAI FILMSAI FILMSAICAIMS EducationALAS AbroadAlas AbroadAlberta EducationAlbertoANABELLA FAZIO SOLE TRADERArmando ParraArrive AustraliaAruna Kingsley MunaweeraAsif Imran KhanAtlas MigrationATLAS MIGRATIONAUSSIESTAY GLOBAL PTY LTDAust Migration and Settlement ServicesAustralia LegalAustralia OnlineAustralia OnlineAustralia Sin LimitesAustralia Student RecruitmentAustralia Study Educational ServicesAustralian AgentAustralian CentreAustralianteAwesome Migration and Education CentreAxiom EducationBadri P JaishiBajwaBapu GohilBe Fresh Education & JobsBe OzzyBee Global ConsultancyBestway InternationalBlues StudiesBluesky Immigration and Students Consultancy ServicesBrave EducationBreeze Study & TravelBridge BlueBridge BlueBridgeMarksBridgeMarksBright International Education Centre Bright Way Education ConsultancyBrilliant Consultants Pty LtdBSC Student ConsultancyCambryCapstone LearningCareersHub BangladeshCBSM ConsultantsCESE AustraliaCHM AgencyChoice intercambioChristie Migration AgentsCI AustraliaClick EducationConnection AustraliaConnection Australia Student ServicesCONNECTION STUDENT LIMITED PTYCreative LinkDalip ChopraDay One IntercambiosDCS Educare (Pvt.) LtdDevtestagent 2Devtestagent 2Direct EnrolmentDirection AustraliaDoppler EducationDream Solution GroupDS EducationE INTERCAMBIO AUSTRALIAE-BIZZ SOLUTIONS PTY. LTD.E-Goal International EducationE-Help Consultancy & Migration ServicesE-Help Consultancy & Migration ServicesEasy OzzyEASYOZZY PTY LTDEdforeignEdu Abroad LimitedEdu MentorEdu-Migrate Information CentreEducation Down Under Visa servicesEducation WayEDUCATION WAY PTY LTDEducational Net operadora de cursos e turismo Ltda.Edumig LimitedEdutravel International Pty LtdEdwise ConsultancyEgaliEGALI INTERCAMBIO PTY LTDElegance Education Consultancy Pty LtdElixir Educational ConsultancyEMSAEnglish World & International ExpressEstudien AustraliaESTUDIEN AUSTRALIA PTY LTDEstudio de Latam Visa LLCExpert ConsultantExpert EducationExpert EducationEXPLOREFaith Overseas LtdFernanda Xavier LealFHTestingAgencyFIRST ONE EDUCATION PTY LTDFluency HubFollow Us IntercambioForeign Education SystemFuture Care ConsultantGlee EducationGlobal Education SystemGlobal experience sacGlobal HeightsGlobal Opportunities Bangladesh LimitedGlow Up StudyGo StudyGoodday ozGrowProGSC Global SolutionsGSS Education PTY., LTDGuardianz EducationHai Education Consultants LTDHana Uhak Pty Ltd - Australia Hello AustraliaHello Australia Pty LtdHub EduHWG AUSTRALIA PTY LTDi-Global ServicesImmi-InternationalInformation Brazil Viagens, Turismo e Intercambio Cultural LTDA – EPPInformation PlanetInformation PlanetInformation Planet Pty LtdInternational Admission & Immigration Consultant (Note: NEW VENTURE ANZ)International Admission & ImmigrationJessica ZunigaKampus GroupKangaroo Education Foundation Education & Visa ServicesKaran SehgalKM IntercambioKS MigrationKWEC PTY LTDLatin AdvisorLead World ConsultantsLeading Education and Migration Consultancy Pty Ltd.Let's go studyLike GlobalLink HouseLINK STUDYLink2 worldLINK2WORLD PTY LTDLIV ConsultingLouis suLVS Education ConsultancyMapa da AustraliaMatrix International Pty LtdMentors' Study AbroadMGC Mega Global Consultancy LtdMood IntercambioMove and StudyMr.Pardeep BalyanMuhammad YousafMy career AustraliaMy MigrationMy Oz ServicesNawab SinghNECL (Netglobal Education Counselling)"New Testing agentNew Way ConsultancyNext Step – Student Agency PTY LTDNexus Studies S.A.SNICENiyata VattanavongsiriNRI EducationNSS SolutionO Papo de IntercâmbioOff 2 AbroadOne Way IntercambioOne Way IntercambioOnecallsolutionOpen ConexusAgent's SignatureDate DD slash MM slash YYYY OFFICE USE ONLYACCEPTED BY WELLS INTERNATIONAL COLLEGE