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Agent Data Entry Form

This document is an agent data entry form for representatives of the University of Western Australia (UWA) to record applicant information that will later be entered into UWA's online application portal. The form collects details such as applicant name, contact information, citizenship and visa details, previous education history, preferred course and intake information, financial support sources, and English language proficiency. It states that this is not an actual application form and should not be sent directly to UWA.

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abhil
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
37 views

Agent Data Entry Form

This document is an agent data entry form for representatives of the University of Western Australia (UWA) to record applicant information that will later be entered into UWA's online application portal. The form collects details such as applicant name, contact information, citizenship and visa details, previous education history, preferred course and intake information, financial support sources, and English language proficiency. It states that this is not an actual application form and should not be sent directly to UWA.

Uploaded by

abhil
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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AGENT

DATA ENTRY FORM


This form is for UWA representatives to record student information to then enter into UWA’s online application portal.
If you wish to apply to UWA, please fill out the details and supply this form to an official UWA representative.
For a list of official UWA representatives near you visit study.uwa.edu.au/how-to-apply/international-agents

This is NOT an application form. Please do not send this form to UWA.

APPLICANT DETAILS
Family name

Given name

Preferred name

Title Date of birth (dd|mm|yyyy) | | Gender M F

Telephone number

Email address
(compulsory)
Residential address (Number and Street, Suburb, State, Country and Postcode)

Mailing address (Number and Street, Suburb, State/Region, Country and Postcode)

CITIZENSHIP AND VISA DETAILS


Country of birth Country of c itizenship

Passport number

Type of visa you are applying for International student visa Temporary resident Other (please specify)

Country of visa application City of visa application

APPLICATION DETAILS
Have you previously studied at UWA? Yes No Student number

Have you lodged any other application to UWA for the period in which you intend to apply? Yes No

Have you previously been offered and deferred the course for which you intend to apply? Yes No

Do you wish to apply for a packaged English language program with your course? Yes No

COURSE PREFERENCES
CHOOSE INTAKE Year February (Semester 1) July (Semester 2)

Course 1 (Name, Code, Major/Specialisation)

Course 2 (Name, Code, Major/Specialisation)

UNDERGRADUATE APPLICANTS ONLY

A: If you would like a packaged offer which includes a postgraduate professional degree following your bachelor’s degree,
please indicate below.

Master of Architecture (MArch) Master of Landscape Architecture (MLarch)

Master of Professional Engineering (MPE) Juris Doctor (JD)

Doctor of Medicine (MD) Doctor of Dental Medicine (DMD) I do not wish to apply for direct entry

note: please check closing dates for the doctor of medicine (md) and doctor of dental medicine (dmd).
AGENT
DATA ENTRY FORM
This form is to record student information to then enter into UWA’s online application portal www.uwa.edu.au/agents/myapplication
This is NOT an application form. Please do not send this form to UWA.

B: If your academic background is assessed by the University as not sufficient for direct entry, you may be eligible for a pathway program.
If you would like your application to be forwarded to one of our pathway partners to be considered for a packaged offer (i.e. Foundation or
Preparatory program + UWA degree) please indicate your preference below.

WA Universities’ Foundation Year Program (WAUFP) UWA Foundation Program

FINANCIAL SUPPORT
Select your source of financial support:

Privately funded Employer sponsored Government sponsored (provide details) External scholarship (provide details)

Details of sponsorship or scholarship (organisation, country)

SECONDARY EDUCATION DETAILS


Country of secondary education Year completed

Qualification name

School Score

TERTIARY EDUCATION DETAILS


Qualification name

Year commenced Year completed Incomplete

Institution

OTHER QUALIFICATION(S)
Qualification name

Date completed (dd|mm|yyyy) | |

Details

WORK EXPERIENCE (CHECK TO SEE IF REQUIRED BY COURSE)


Position

Employer

Start date (dd|mm|yyyy) | | End date (dd|mm|yyyy) | |

Contact (address | telephone | email)

ENGLISH COMPETENCY
Type of test

Year achieved

Score/Grade

CRICOS Provider Code: 00126G UniPrint 119624

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