International Application FormAbout this form

Welcome to the University of Tasmania’s on-line application form for International applicants. You should use this form to apply to study at the University of Tasmania, including the Australian Maritime College, a specialist institute of the University, for the following courses:

• English with our English Language Centre; and/or• Foundation Studies Program; and/or• A diploma or degree program.

Please allow about 20 minutes to complete your application.

Personal Information

* Title

Mr* Family name

Aprian

* Date of birth

21 Apr 1993

Gender

Male*

Given names

Mukti*

Country of citizenship

Indonesia*

Country of birth

Indonesia*

Language spoken at home

Indonesian*

Previous Study at UTAS

Have you previously been a student at UTAS or AMC?Yes No✔

*

Applicant Contact Details

* Email

mukti@kampalafpunib.org

* Confirm Email

mukti@kampalafpunib.org

Country/Area code

62

Mobile

82281387533e.g. 613 e.g. 62123456

Country/Area code Home Phone

e.g. 613 e.g. 62123456

Home Address

Country

Indonesia*

Address line 1

Jl MH Thamrin no 19 Kel Air Rambai* Address line 2

City

Curup* State / Province / Region

Rejang Lebong/Bengkulu* Zip / Postal code

39111*

Correspondence Address

Same as home address✔

Scholarship / Sponsorship

Are you applying for a scholarship in your home country, or receiving sponsorship from your home country?

Scholarship✔

Name of scholarship and organisation providing scholarship

LPDP

Please attach evidence of scholarship

Sponsorship

Siblings at UTAS

Do you have a brother or sister currently or previously enrolled at UTAS?Yes No✔

*

Counsellor or Agent Details

Are you applying through an agent?Yes No✔

*

Please note: if you receive an offer of enrolment and are eligible for stream-lined visa processing you will be required to appoint an agent to assist with the acceptance process.

Proposed Course of Study

Course path

English Only

Degree Only

Foundation Studies Program -> Degree

English -> Degree

English -> Foundation Studies Program -> Degree✔

*

English Language Proficiency Test

Have you taken an English language proficiency test in the past two years?

Yes✔ No

*

IELTS (Academic)✔

IELTS (Academic) Test Report Form Number

14ID000997APRM035A*

TOEFL (PBT)

TOEFL (iBT)

PTE Academic

UTAS Access (Direct Entry)

Cambridge CAE (Certificate of Advanced English)

Cambridge CPE (Certificate of Proficiency in English)

Cambridge BEC (Business English Certificate) Higher

Password Test for English Language Placement

Other test

English Language Centre

Preferred Course

Maritime English Direct Entry Program (MEDEP)* Total number of weeks

5 weeks*

Intended start date

9 June 2015* Campus

Launceston*

Please attach a copy of your IELTS / TOEFL results

Foundation Studies Program

UTAS Foundation offers 3 streams of study. Choice of stream will depend on the subject prerequisites for your undergraduate degree. Please select a stream:

Foundation Stream

Science and Engineering (FSP)* Course Year

2015* Course Semester

Semester 1* Campus

Hobart*

Proposed Course of Study

Course Preference 1

Course level

Masters by Coursework*

Course name

Master of Applied Science (Marine Environment) with Honours J7V*

Specialisation

Marine Conservation

Course Year

2015* Course Semester

Semester 1* Campus

Launceston*

Course Preference 2

Course level

Masters by Coursework*

Course name

Master of Applied Science (Marine Environment) J7T*

Specialisation

Marine Conservation

Course Year

2015* Course Semester

Semester 1* Campus

Launceston*

Course Preference 3

Course level

Masters by Coursework*

Course name

Master of Business Administration (Maritime Technology and Management) 27E*

Course Year

2015* Course Semester

Semester 1* Campus

Launceston*

Secondary Educational Qualifications

Please provide full details of your secondary education

Are you currently studying (or have you already completed) Year 12 in Australia?

Yes No✔

*

Overseas Secondary School 1

* Program

Sekolah tanda tamat belajare.g. STPM, Senior Middle 3, GCE A levels, GCSE O Levels, Higher School Certificate or polytechnic diploma

School / Institution

SMA N 1 Curupe.g. Methodist Boys School, Pulau Pinang

*

Country

Indonesia* Year started

2007* Year ended

2010* Completed

Yes✔ No*

If you are CURRENTLY completing the final year of your secondary qualifications, please indicate the date your results will be available.

Post-Secondary Educational Qualifications

Have you completed post-secondary education?

Yes✔ No*

Post-Secondary qualification 1

Program

Marine Science*

School / Institution

University Of Bengkulu*

CompletedYes✔ No

* Country

Indonesia* Year started

2010* Year ended

2014*

Are you seeking Advanced Standing/Credit for this qualification?Yes✔ No

*

If you are CURRENTLY completing a post-secondary qualification (e.g. degree, diploma, etc.), please indicate the date your final results will be available.

In order for us to assess your request for advanced standing/credit, please attach detailed course syllabuses and unit outlines of subjects you have successfully completed. Applications for advanced standing cannot be fully assessed without this information.

Feedback

How did you hear about the University of Tasmania?

Exhibition / seminar

Newspaper / radio advertising

Recommended by School Counsellor

Education agent

Australian Embassy / High Commission

Web Search✔

Friends / Family

Other

Comments

Supporting Documentation Required

To enable assessment of your application, please make sure you attach the following supporting documentation. Click on the button below to attach your documents.

• Academic transcripts and certificates for all qualifications listed in the application

• Copy of your passport (if available)

• Scholarship details

• English Language Proficiency Test details

• IELTS / TOEFL results

• Course syllabus to support your request for advanced standing/credit

Declaration

By submitting this application I declare that the information provided in this application and the documentation supporting it is true and complete. I understand that the University reserves the right to vary, reserve or cancel any decision regarding admission or enrolment made on the basis of incorrect information. I understand that the information that I have provided to the University may be made available to Commonwealth and State agencies pursuant to obligations under the Education Services for Overseas Students Act 2000 and the National Code of Practice for Registration Authorities and Providers of Education and Training to Overseas Students 2007. I accept that the information I provide on this form and during my enrolment can be provided, in certain circumstances, to the Australian Government and designated authorities, including sponsor agencies, and, if relevant, the Tuition Protection Service Director. I further understand that it may be disclosed to third parties for the purpose of progressing my application. I recognise that the University is required by law to inform the Department of Industry, Innovation, Science, Climate Change, Research and Tertiary Education and the Department of Immigration and Citizenship of certain changes to my enrolment and of any breach of a student visa condition relating to satisfactory academic performance. I understand that all my personal information will be managed in accordance with the Personal Information Protection act 2004 and the University’s Privacy Policy. I authorise the university to contact me by SMS.