Web Form for PIA Applications

Personal Information

Title (as per passport)

Passport has only one set of names?

Yes - the passport only has given name(s)

Yes - the passport only has family name(s)/surname(s)

No - the passport has both given and family name(s)/surname(s)

Family name(s)/Surname(s) (as shown on passport)

Family name(s)/Surname (as shown on passport where there is no given name(s)

Given Name(s) (as shown on passport)

Preferred Name

Birth Date

Gender

Female

Male

Nationality

Type of Application

Please choose the campus that will be your home campus

When would you like to start at the Melbourne City Campus?

Country of Birth

Passport Number

Please re-enter the Passport Number

Passport Date of Expiry

Year of Arrival in Australia

Country of Residence (what country will you return to when your visa expires?)

Current E-mail Address

Current Mobile Number

Current Home Phone Number

Australian Indigenous Person Status

Main Language Spoken At Home

Are you using an Education Agent?

Yes

Education Agent of Applicant

Education Agent Email Address (for communication about this application)

Address and Visa Details

This is your current contact details whether you are in Australia or not

Country

Unit/Flat Number

Street/Lot Number

Street Name

Suburb

Post Code

State

Overseas State/Province

Is your postal address different to your home address

Yes

Address - Postal - Country

Address - Postal - Unit/Flat Number

Address - Postal - Street/Lot Number

Address - Postal - Street Name

Address - Postal - Suburb

Address - Postal - State

Address - Postal - Post Code

Address - Postal - Overseas State/Province

Visa Status

Visa Education Sector

Visa Type

Visa Subtype

Visa Number

International - Visa Expiry Date

To be granted a student visa, applicants must be both a Genuine Student and a Genuine Temporary Entrant.

Will you have family (husband/wife/children/de facto partner) accompanying you to Australia either
(a) included in your visa application or
(b) joining after you have had your visa granted as a subsequent entrant?

The forms can be found at https://docs.pia.edu.au/forms/

Yes – Please complete: Statement of Purpose (SOP) Genuine Student (GS) and Genuine Temporary Entrant (GTE) Profile Dependent Applicant Form

No – Please complete: Statement of Purpose (SOP) Genuine Student (GS) and Genuine Temporary Entrant (GTE) Profile Single Applicant Form

Education Details

Please enter details of your previous education

Highest Level of Education

Year completed Highest Education

Have you completed any education in Australia prior to this course you are applying for?

Not Stated

Yes

Prior Education Type - tick all that apply

Unique Student Identifier (USI)

Have you studied a course in Australia, or elsewhere, that is similar to the one for which you are applying for which you would like credit?

Yes

If you have answered yes, please attach the Credit application form and all relevant documentation, as you may be eligible for credit for your course. Please ensure that you have provided sufficient supporting evidence for consideration. Applications submitted with insufficient evidence will be rejected. Please read the Credit and Recognistion of Prior Learning Policy and Procedure on the www.pia.edu.au website.

Note: Specific Evidence table forms are available at https://docs.pia.edu.au/documents.html

Do you need to complete an English for Academic Purposes (EAP) program?

Yes

Which EAP program to complete

EAP1

EAP2

Preferred starting date for EAP program

EAP Program Duration (in weeks)

Special needs

To ensure your success the Institute needs to ask the following question.

Do you have any of the disabilities listed in the next question?

Not Stated

Yes

Do you have any of the following disabilities which may affect your learning?

OVERSEAS STUDENT HEALTH COVER (OSHC)

Overseas Student Health Cover (OSHC) must be arranged for the duration of your visa as a condition of your student visa. PIA can arrange health cover with BUPA (our preferred provider) on your behalf for the duration of your visa. If you pay the full OSHC amount up-front, you are protected against any increases in the OSHC fees for the duration of your visa. If you complete your studies earlier than expected, you may be entitled to a refund from BUPA. Health insurance is your responsibility and current cover must be maintained by students for the duration of their stay in Australia.

This service is provided via “BUPA”. www.bupa.com.au

(Note that prices provided are based on individual student needs and will be emailed to you once the type of cover has been selected.)

Will you arrange your own health cover?

Yes

Type of Cover

Single

Couple

Period Insurance required for

Uploads

A certified copy is a copy of an original document that has been verified as an authentic copy by an authorised person who has sighted the original document. A certified copy should include the certifier’s name, signature, date of certification and agency/organisation stamp.

An authorised person includes – a Polytechnic Institute Australia authorised representative, public notary, justice of the peace, commissioner for declarations, or a Polytechnic Institute Australia staff member.

A certified official translation are translations performed by a National Accreditation Authority for Translators and Interpreters (NAATI - naati.com.au) accredited translator

Copy of the personal details page of your passport

Copy of your English language qualification or provide details of your English proficiency

Copy of all academic qualifications, including secondary school studies

Copy of Visa (if applicable)

Additional documents where applicable and as outlined by the course entrance requirements - eg. folio, personal statement

1 passport size photograph

Documentation verifying name change - if your academic documents are under a previous name

Official translation of any document not in English

Statement of Purpose (SOP) Genuine Student (GS) and Genuine Temporary Entrant (GTE) Profile Applicant Form (Dependent/Single) Form

Privacy Declaration Notice

Polytechnic Institute Australia is committed to the responsible collection and handling of your personal information in accordance with all relevant legislation, including the Privacy Act 1988. The personal information collected on this form will be used for the purposes of assessing and processing your application. Your personal information may be disclosed to Commonwealth and State Agencies such as the Department of Education and Training, and The Department of Home Affairs pursuant to reporting obligations under applicable legislation. Your personal information will also be disclosed to your overseas student health care provider and, if you are under 18 years of age, to the carer appointed for you in accordance with the National Code established under the Education Services for Overseas Students Act 2000. Your information will not be disclosed to other third parties without your consent. You have a right to access personal information that Polytechnic Institute Australia holds about you. See Polytechnic Institute Australia Privacy Policy for details, which can be accessed at http://www.pia.edu.au/student-info/policies-procedures

Declaration

I, (insert name below)

By ticking this box declare that:

• I understand that Information contained in these forms may be provided to the state and Commonwealth agencies and research organisations and consent to that occurring.

• The information submitted in this application is correct and complete.

• I acknowledge that my admission and continued enrolment will be subject to Polytechnic Institute Australia policies and procedures.

• I agree that the Institute may obtain official records from my previous employers or providers I attended.

• I undertake to advise the Institute immediately of any changes to the information submitted in this application.

• I consent to the above information being maintained in the Institute’s records for administration and academic purposes and reported to the regulatory authorities for official purposes.

• I understand that Polytechnic Institute Australia may be required to report to the relevant Government authorities the progress of my application and or subsequent student status.

• I consent to my information being held securely by the relevant regulatory authority and that my information may be disclosed to the Department of Education, Skills and Employment and the Department of Home Affairs. Polytechnic Institute Australia will not otherwise disclose the information without my consent unless required or authorised by law.

• I hereby certify that the information provided on this form, and on all documents submitted may be made available to Commonwealth and State agencies pursuant to obligations under the ESOS Act 2000 and the National Code 2018. I understand that the institution is required under section 19 of the ESOS Act 2000 to inform Department of Education, Skills and Employment and the Department of Home Affairs of changes to my enrolment and any breach of a student visa condition relating to attendance or unsatisfactory academic performance.

• I declare that I have read and understood Polytechnic Institute Australia fee schedule, conditions of enrolment, privacy statement and refund policy and have familiarised myself with other relevant policies located on the PIA website and agree to be bound by them.

• I undertake to advise Polytechnic Institute Australia immediately of any changes to the information submitted in this application.

• I have fully read and understood the Institute’s terms and conditions.

• I declare that I have the financial capacity to meet course fees and agree to pay these fees as they become due and I have read, fully understood and accept the Institute's terms and conditions.

Digital Signature

Draw It
Clear

Date

Education Agent comments concerning the application

This course is currently not open for enrolments