Australian Student Visa Application Form (US)

Personal details

• Given names * Given names can not be empty
• Family name * Family names can not be empty
• Sex Sex Male Female * Please choose your sex
• Date of birth Day 12345678910111213141516171819202122232425262728293031 Month JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC Year 19701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016 * Birth day must be before today
• Relationship status Relationship status Divorced Engaged De Facto Married Never Married Separated Widowed Field Relationship status must have a value
• Do you have any dependent children? > Yes No Field Relationship status must have a value
• Your place of birth
• Town/City * Please input your city
• State or Province This field must have a value
• Country of birth Country of birth AFGHANISTANALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA & HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRIT DEPEND TERR CITBRIT INDIAN OCN TERRBRITISH WEST INDIESBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPCHADCHANNEL ISLANDSCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLCOLOMBIACOMOROSCONGOCOOK ISLANDSCOSTA RICACOTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICCZECHOSLOVAKIADENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICTIMOR, EASTECUADOREGYPTEL SALVADORENGLANDEQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDSFAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFYR MACEDONIAGABONGAMBIAGAZA STRIPGEORGIAGEORGIA/SANDWICH ISLGERMAN DEM REPUBLICGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUINEAGUERNSEYGUINEA-BISSAUGUYANAHAITIHEARD & MCDONALD ISLHONDURASHONG KONG SARHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELAND, REPUBLIC OFISLE OF MANISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA (SO STATED)KOREA, NORTHKOREA, SOUTHKOSOVOKUWAITKYRGYZSTANLAO PEOPLES DEM REPLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMACAU SPCL ADMIN RGNvMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIAMOLDOVAMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW GUINEANEW HEBRIDESNEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN IRELANDNORTHERN MARIANA ISLNORWAYOMANPAKISTANPALAUPALESTINIAN AUTHORTYPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPLEASANT ISLANDPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIAROMANIA PRE 1/2/2002RUSSIAN FEDERATIONRWANDASAINT BARTHELEMYSAINT LUCIASAINT MARTINSAMOASAN MARINOSAO TOME & PRINCIPESAUDI ARABIASCOTLANDSENEGALSERBIASERBIA AND MONTENEGROSEYCHELLESSIERRA LEONESIKKIMSINGAPORESLOVAK REPUBLICSLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH SUDANSPAINSRI LANKAST HELENAST KITTS AND NEVISST PIERRE & MIQUELONST VINCENT/GRENADINESUDANSURINAMESVALBARD & JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIATAHITITAIWANTAJIKISTANTANZANIATHAILANDTIBET (SO STATED)TIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLTUVALUU.S. MINOR ISLANDSU.S.S.R.UGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATESURUGUAYUZBEKISTANVANUATUVATICAN CITY STATEVENEZUELAVIETNAMVIRGIN ISLNDS (BRIT)VIRGIN ISLANDS (U.S)WALESWALLIS & FUTUNA ISLWEST BANKYEMENYUGOSLAVIAZAIREZAMBIAZIMBABWE * please select your country of birth
• Your country of residence
• Select your country of usual residence from the list provided. You will be asked later in this application to provide your full residential address in this country.
• Country of residence Country of residence AFGHANISTANALBANIAALGERIAAMERICAN SAMOAANDORRAANGOLAANGUILLAANTIGUA AND BARBUDAARGENTINAARMENIAARUBAAUSTRALIAAUSTRIAAZERBAIJANBAHAMASBAHRAINBANGLADESHBARBADOSBELARUSBELGIUMBELIZEBENINBERMUDABHUTANBOLIVIABOSNIA & HERZEGOVINABOTSWANABOUVET ISLANDBRAZILBRIT DEPEND TERR CITBRIT INDIAN OCN TERRBRITISH WEST INDIESBRUNEI DARUSSALAMBULGARIABURKINA FASOBURUNDICAMBODIACAMEROONCANADACAPE VERDECAYMAN ISLANDSCENTRAL AFRICAN REPCHADCHANNEL ISLANDSCHILECHINACHRISTMAS ISLANDCOCOS (KEELING) ISLCOLOMBIACOMOROSCONGOCOOK ISLANDSCOSTA RICACOTE D'IVOIRECROATIACUBACYPRUSCZECH REPUBLICCZECHOSLOVAKIADENMARKDJIBOUTIDOMINICADOMINICAN REPUBLICTIMOR, EASTECUADOREGYPTEL SALVADORENGLANDEQUATORIAL GUINEAERITREAESTONIAETHIOPIAFALKLAND ISLANDSFAROE ISLANDSFIJIFINLANDFRANCEFRENCH GUIANAFRENCH POLYNESIAFYR MACEDONIAGABONGAMBIAGAZA STRIPGEORGIAGEORGIA/SANDWICH ISLGERMAN DEM REPUBLICGERMANYGHANAGIBRALTARGREECEGREENLANDGRENADAGUADELOUPEGUAMGUATEMALAGUINEAGUERNSEYGUINEA-BISSAUGUYANAHAITIHEARD & MCDONALD ISLHONDURASHONG KONG SARHUNGARYICELANDINDIAINDONESIAIRANIRAQIRELAND, REPUBLIC OFISLE OF MANISRAELITALYJAMAICAJAPANJERSEYJORDANKAZAKHSTANKENYAKIRIBATIKOREA (SO STATED)KOREA, NORTHKOREA, SOUTHKOSOVOKUWAITKYRGYZSTANLAO PEOPLES DEM REPLATVIALEBANONLESOTHOLIBERIALIBYALIECHTENSTEINLITHUANIALUXEMBOURGMACAU SPCL ADMIN RGNvMADAGASCARMALAWIMALAYSIAMALDIVESMALIMALTAMARSHALL ISLANDSMARTINIQUEMAURITANIAMAURITIUSMAYOTTEMEXICOMICRONESIAMOLDOVAMONACOMONGOLIAMONTENEGROMONTSERRATMOROCCOMOZAMBIQUEMYANMARNAMIBIANAURUNEPALNETHERLANDSNETHERLANDS ANTILLESNEW CALEDONIANEW GUINEANEW HEBRIDESNEW ZEALANDNICARAGUANIGERNIGERIANIUENORFOLK ISLANDNORTHERN IRELANDNORTHERN MARIANA ISLNORWAYOMANPAKISTANPALAUPALESTINIAN AUTHORTYPANAMAPAPUA NEW GUINEAPARAGUAYPERUPHILIPPINESPITCAIRNPLEASANT ISLANDPOLANDPORTUGALPUERTO RICOQATARREUNIONROMANIAROMANIA PRE 1/2/2002RUSSIAN FEDERATIONRWANDASAINT BARTHELEMYSAINT LUCIASAINT MARTINSAMOASAN MARINOSAO TOME & PRINCIPESAUDI ARABIASCOTLANDSENEGALSERBIASERBIA AND MONTENEGROSEYCHELLESSIERRA LEONESIKKIMSINGAPORESLOVAK REPUBLICSLOVENIASOLOMON ISLANDSSOMALIASOUTH AFRICASOUTH SUDANSPAINSRI LANKAST HELENAST KITTS AND NEVISST PIERRE & MIQUELONST VINCENT/GRENADINESUDANSURINAMESVALBARD & JAN MAYENSWAZILANDSWEDENSWITZERLANDSYRIATAHITITAIWANTAJIKISTANTANZANIATHAILANDTIBET (SO STATED)TIMOR-LESTETOGOTOKELAUTONGATRINIDAD AND TOBAGOTUNISIATURKEYTURKMENISTANTURKS AND CAICOS ISLTUVALUU.S. MINOR ISLANDSU.S.S.R.UGANDAUKRAINEUNITED ARAB EMIRATESUNITED KINGDOMUNITED STATESURUGUAYUZBEKISTANVANUATUVATICAN CITY STATEVENEZUELAVIETNAMVIRGIN ISLNDS (BRIT)VIRGIN ISLANDS (U.S)WALESWALLIS & FUTUNA ISLWEST BANKYEMENYUGOSLAVIAZAIREZAMBIAZIMBABWE * Please select your country of residence
• Your passport details
• Country of passport Country of passport BELGIUMCANADACYPRUSDENMARKESTONIAFINLANDFRANCEGERMANYHONG KONG SARIRELANDITALYJAPANKOREA, SOUTHMALTANETHERLANDSNORWAYSWEDENTAIWANUNITED KINGDOMUNITED STATES * Please select country of passport
• Passport number * Please input your passport number The passport number's format is incorrect
• Passport date of issue Day 12345678910111213141516171819202122232425262728293031 Month JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC Year 200120022003200420052006200720082009201020112012201320142015201620172018201920202021 * Passport date of issue is invalid
• Passport date of expiry Day 12345678910111213141516171819202122232425262728293031 Month JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC Year 202120222023202420252026202720282029203020312032203320342035203620372038203920402041 * Passport date of expiry is nvalid
• Passport place of issue * Passport place of issue cannot be empty
• If you have an Australian visa grant number, please enter the visa grant number
• Grant number
• If you have a current Australian visa label in your current or previous passport, please enter the visa number
• Visa number
• Health Examination
• Have you undertaken a health examination for an Australian visa in the last 12 months?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• Please enter the HAP ID (if known)
• Your proposed arrival date Day 12345678910111213141516171819202122232425262728293031 Month JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC Year 202120222023202420252026 The date must after today
• Your proposed departure date Day 12345678910111213141516171819202122232425262728293031 Month JANFEBMARAPRMAYJUNJULAUGSEPOCTNOVDEC Year 202120222023202420252026 The date must after today
• Proposed incoming flight number or vessel details (if known) This field must have a value
• Proposed duration of stay in Australia This field must have a value
• Are you known by any other names? (This includes names before marriage.)
•   No Yes This field must have a value

• Do you hold any other citizenship than that shown as your Passport Country above?
•   No Yes This field must have a value

• What type of education qualification do you intend to complete in Australia? Please Select Qualification English Language Intensive Courses (ELICOS) PHD Masters Degree (Research) Masters Degree (Coursework) Bachelor Degree Associate Degree Advanced Diploma Graduate Diploma Graduate Certificate Diploma Certificate Level 1, 2, 3 or 4 Secondary School Primary School None of the above This field must have a value
• How would you rate your English language ability? Please Select Language Ability Very Good (Competent) Good (Vocational) Poor This field must have a value
• Are you currently studying in Australia on a Student Visa? Yes No This field must have a value
• How are your studies in Australia to be funded? Self funded Sponsorship by the government of your country or a multi-lateral agency Sponsorship by an approved Australian non-Government organization Sponsorship by a scholarship none of the above This field must have a value

• Please provide the Confirmation of Enrolment (CoE) code for each course you will be completing?
  The CoE is located in the top right corner of your Confirmation of Enrolment.

• Course 1: This field must have a value
• Course 2: This field must have a value
• Course 3: This field must have a value

• Residential address details

• Give details of the residential address in your home country.
• Address * Please input your address
•   * Please input your address
• Suburb/Town * Please input your city
• State or Province * Please select a province
• Postcode * Please input your postcode
• Country
• Your contact telephone numbers
• Mobile/Cell phone (please include country code)
  +
  Please enter your mobile phone number (please include country code)

• Health declarations

• You are required to answer the following questions for yourself and any other person included in the application.
• In the last 5 years have you visited or lived outside for more than 3 consectutive months?
•   No Yes This field must have a value
• Do you intend to enter a hospital or a health care facility (including nursing homes) while in Australia?
•   No Yes This field must have a value
• Do you intend to work as, or study to be, or train to be, a doctor, dentist, nurse or paramedic during your stay in Australia?
•   No Yes This field must have a value
• Do you intend to work, or be a trainee, at a child care centre (including preschools and creches) while in Australia?
•   No Yes This field must have a value
• Have you:
  1. ever had, or currently have, tuberculosis?
  2. been in close contact with a family member that has active tuberculosis?
  3. ever had a chest x-ray which showed an abnormality?
•   No Yes This field must have a value
• During your proposed visit to Australia, do you expect to incur medical costs, or require treatment or medical follow up for:
• blood disorder No Yes This field must have a value
• cancer No Yes This field must have a value
• heart disease No Yes This field must have a value
• hepatitis B or C No Yes This field must have a value
• liver disease No Yes This field must have a value
• HIV infection, including AIDS No Yes This field must have a value
• kidney disease, including dialysis No Yes This field must have a value
• mental illness No Yes This field must have a value
• pregnancy No Yes This field must have a value
• respiratory disease that has required hospital admission or oxygen therapy No Yes This field must have a value
• other? No Yes This field must have a value
• Do you require assistance with mobility or care due to a medical condition?
•   No Yes This field must have a value
• Do you hold health insurance to cover your stay in Australia?
•   No Yes This field must have a value
• Have you undertaken a health examination for an Australian visa in the past 12 months?
•   No Yes This field must have a value

• Visa applicants are encouraged to be immunised against infectious diseases before travelling to Australia. Visa applicants who are unable to arrange their immunisation before departure from their home country are encouraged to seek advice on arrival in Australia. The Australian state and territory health authorities assist people to obtain general medical help and advice, including immunisation. Parents are strongly encouraged to have their children immunised against hepatitis B, diphtheria, tetanus, pertussis (whooping cough), poliomyelitis, haemophilus influenzae type-b (Hib), pneumococcal and meningococcal infections, mumps, measles, rubella and varicella (chickenpox). Babies between the ages of 2 and 8 months of age (only) are also encouraged to be immunised against rotavirus.

  Parents should bring any immunisation records for their children with them to Australia.

  Rubella vaccinations are strongly encouraged for women of child-bearing age.

• Character declarations

• If you wish to study in Australia, you must be of good character. The following questions ask details of your character. If your circumstances change before you travel you should inform the Australian Government office overseas. If you are receiving assistance in completing this form, you must ensure you personally answer these questions, and that the answers are faithfully transcribed to this form. For your reference, a copy of the questions can also be found in form 157A Application for a student (temporary) visa
• Have you, or any person included in this application to apply for this visa, ever:
• been convicted of a crime or offence in any country (including any conviction which is now removed from official records)?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• been charged with any offence that is currently awaiting legal action?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• been removed or deported from any country (including Australia)?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• left any country to avoid being removed or deported?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• been excluded from or asked to leave any country (including Australia)?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• committed, or been involved in the commission of war crimes or crimes against humanity or human rights?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• been involved in any activities that would represent a risk to Australian national security?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• had any outstanding debts to the Australian Government or any public authority in Australia?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)?
•   No Yes This field must have a value
• If Yes, please give details This field must have a value
• 1. served in a military force or state-sponsored or private militia, or
  2. undergone any military or paramilitary training, or
  3. been trained in weapons or explosives use (however described),
  other than in the course of compulsory national military service?
•   No Yes This field must have a value

• Processing details

• Have you, or any person included in this application held or currently hold a visa for travel to Australia?
•   No Yes This field must have a value
• Have you, or any person included in this application ever been refused an entry permit or visa to Australia?
•   No Yes This field must have a value
• Have you, or any person included in this application ever had a visa cancelled?
•   No Yes This field must have a value
• Are you, or any person included in this application currently awaiting a decision on another visa application (not including this application)?
•   No Yes This field must have a value

• Declaration

• I declare that:
• • I have read the information contained in the www.studyinaustralia.gov.au website on living and studying in Australia including information on the cost of living, accommodation and employment.
•   No Yes This field must have a value
• • The information I have supplied in this application is complete, correct and up-to-date in every detail.
•   No Yes This field must have a value
• • I am aware that I must immediately advise the department if I become aware that any information provided in this form is incorrect or if there is a change in my circumstances that is relevant to this application at any time.
•   No Yes This field must have a value
• • I will attach all relevant documentary evidence as specified on the department's website for the student visa for which I am applying as soon as I have been provided with the Transaction Reference Number (TRN). I acknowledge that the department's online lodgement facility will provide me a webpage link to attach the relevant documentary evidence once I have been provided with the TRN (Note: the TRN will be provided to you after you pay your visa application fee(s) and before you exit the visa application).
•   No Yes This field must have a value
• • I understand that if any fraudulent or misleading documents or information is found, this application is likely to be refused and I may become ineligible to be granted a visa for a period of time.
•   No Yes This field must have a value
• • I have access to sufficient funds to support myself and my family unit members (regardless of whether they are accompanying me to Australia) for the total period of my stay in Australia*.
•   No Yes This field must have a value
• • I have made adequate arrangements to health insurance for the period of my stay in Australia and I acknowledge that I am required to maintain these arrangements while in Australia as the holder of a student visa.
•   No Yes This field must have a value
• • I will respect Australian values as listed on this form, during my stay in Australia and will obey the laws of Australia.
•   No Yes This field must have a value
• • I understand that a student visa is a temporary visa, and that being granted a student visa will not guarantee that I will be eligible for the grant of a further visa to remain in Australia, including a skilled migration visa.
• • I understand that if I cannot obtain a further visa, I must depart Australia on or before the cease date of the student visa.
•   No Yes This field must have a value
• • Visa conditions:
• If granted a student visa, I acknowledge that I am required to abide by its conditions as outlined in the information sheet Applying for a student visa.
•   No Yes This field must have a value
• • I understand that if the 8534 visa condition is imposed on my visa, it will be indicated by the condition code '8534' and by the short description 'Further stay restricted'. I acknowledge that this means that the 8534 condition has been imposed on my visa and that I will not, while in Australia, be entitled to the grant of any other visa**, other than a subclass 580 (Student Guardian) visa.
• • I understand that the effect of the 8534 visa condition is that it will not be possible for me to apply to remain in Australia beyond the date authorised by my visa** and that I will be required to depart Australia on or before that date. I agree to having this condition included on any visa issued to me as the result of this application if the department decides to impose it as a condition of grant of a visa.
• • I understand that if the 8535 visa condition is imposed on my visa, it will be indicated by the condition code '8535' and by the short description 'Further stay restricted'. I acknowledge that this means that the 8535 condition has been imposed on my visa and that I will not, while in Australia, be entitled to be granted any other visa** other than a further visa in circumstances where the Commonwealth, or a foreign government (as the case requires), does not oppose me undertaking a relevant course of study.
• • I understand that the effect of the 8535 visa condition is that it will not be possible for me to remain in Australia beyond the date authorised by my visa**, unless I am applying for a further student visa in circumstances where the Commonwealth, or a foreign government (as the case requires), does not oppose me undertaking a relevant course of study, and that I will be required to depart Australia on or before the authorised date.
•   No Yes This field must have a value