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Online English Course Application

* indicates a required field.

Which course? *
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If "General English", how many weeks of study:
Preferred campus of study: *
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Preferred starting date: * (day/month/year/)
Name:

Surname or family name: *

First or given name: *

Second given name:
Gender: *
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Date of Birth: * (day/month/year/)
Citizenship:
Print your country of citizenship as shown in your passport

Country:  *

Passport Number: *
What type of visa do you intend to travel on? *
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What is your address in your home country?

Address: *

Telephone: *

Fax:

Email: *
What is your address?
(if different from above)

Address:

Telephone:

Fax:

Email:
Have you taken an English language proficiency test? *
(eg IELTS, TOEFL)
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Declaration: 
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By submitting this online application I am confirming that I have read and understood the CQUniversity Refund Policy included in the downloadable brochure and agree to the terms and conditions.

I understand that, if I have a Student Visa, CQUniversity is required under Section 19 of the ESOS Act 2000 to inform the Department of Immigration and Citizenship (DIAC) about:

  1. Changes to my program enrolment;
  2. Any breach of my Student Visa condition in relation to attendance.

Please note: Prior to commencement it is important that all prospective English Language Centre students read specific program information which is available on this website and in the CQUniversity English Language Centre Prospectus which can be downloaded from this site. It is important that you become familiar with the CQUniversity English Language Centre's Refund Policy and English Language Centre Courses Dates and Fees List.

The information provided by the student to the provider may be made available to Commonwealth and State agencies and the Fund Manager of the ESOS Assurance Fund, pursuant to obligations under the ESOS Act 2000 and National code.

I declare that the information supplied by me on this form is true and correct in every particular. I have read, understood and agree to these terms and conditions. I authorise CQUniversity to obtain from other educational institutions and relevant authorities details of my enrolment, academic records and examination results.