PART A PAGE 1 OF 6

International Application for Admission

Please refer to the back of this document for instructions on how to complete this form.
Please use BLOCK/CAPITAL letters, indicate with “N/A” where questions are not applicable
and tick boxes where appropriate.

1. APPLICANT TYPE
English Pathway Program Academic Pathway Program Undergraduate Postgraduate: Coursework Research

2. YOUR DETAILS
2.1 Have you been a student previously at Notre Dame?
No Yes If yes, please indicate your previous student number

2.2 Title First name Family / Surname Second / Middle name

Date of birth (day/month/year) Gender Given name as shown in your passport (if different to above)
– – Male Female

Have you been known by another name? Yes No If so, what was your previous name?

2.3 CONTACT INFORMATION

Permanent address in home country

Address

Town/suburb

State/country Postcode

Telephone (include country code) Mobile/cell

Email

Notification address – this address is for all correspondence during the application process. Print ‘as above’ if the same as home address.

Address

Town/suburb

State/country Postcode

Telephone (include country code) Mobile/cell

2.4 PASSPORT DETAILS (If you are a Safe Haven/Humanitarian visa holder, please provide a copy of your ImmiCard).
Passport number Expiry date

Country of citizenship Country of birth

2.5 LANGUAGES – Please list all languages spoken at home in order of use.

2.6 MEDICAL OR SPECIAL NEEDS – disclosing this information will not affect your admission to the University.
Do you have a disability or impairment? Yes No If yes, please indicate the disability or impairment below:

Acquired brain injury Mental health condition Physical disability

Intellectual disability Deaf / deaf Other disability
Neurological condition Low vision / blind
Do you require medical or disability support
Specific learning disability Medical condition during your studies? Yes No

3. APPLICATION TO STUDY – if you are applying for a research program, please ensure to complete PART C of this form.

3.1 Program preferences – Campus Fremantle Sydney

1. Program name Program code

2. Program name Program code

3. Program name Program code

Intended commencement of study program (see notredame.edu.au/current-students/your-enrolment/calendars-and-timetables):

Year Semester 1 Semester 2

Do you intend to apply for advanced standing (credits or exemptions) based on your previous studies? Yes No

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 PAGE 2 OF 6

3.2 Educational background

Please indicate the highest level of your secondary schooling and the year in which this was completed
Year 11 Year 12 or equivalent Completed in calendar year Y Y Y Y
Please note, for on-shore applicants completing ATAR, Equity Group Adjustments, as determined by the University, may apply.

3.2.1 Please indicate the studies you have completed (or intend to complete) and the year in which you completed (or expect to complete),
the qualification. If you have completed more than one qualification at the same level, please indicate the most recently completed
qualification and year:

Date completed
Qualification Country Year Last year (or expected date
(A-levels, Diploma, Degree, etc.) Institution name awarded commenced of enrolment of completion)

Have you ever failed, been excluded (or are you facing exclusion) from a course on academic or other grounds? Yes No

If you answered ‘Yes’ to this question, please provide a written explanation of your course failure or program exclusion and all relevant
academic transcripts with this application form.
Are you currently studying at another institution in Australia or have you recently been issued with any
electronic Confirmations of Enrolment? Yes No
If yes, please complete the details below and provide a copy of all currently held electronic Confirmations of Enrolment.

3.3 English proficiency – is English your first language? Yes No

Students must demonstrate evidence of having a level of English sufficient to succeed in their chosen program of study. Further
information regarding recognised English proficiency tests, minimum scores, and study that can be used to demonstrate English
proficiency see notredame.edu.au/international/how-to-apply.

Please select one of the following:

I have taken a recognised English proficiency test

Name of test Score Date of test D D – M M – Y Y Y Y

I will take a recognised English proficiency test on D D – M M – Y Y Y Y

I have undertaken relevant secondary or tertiary study which demonstrates English proficiency (see notredame.edu.au/international/how-to-apply)

4. DECLARATION OF AUTHORISATION TO ACT ON YOUR BEHALF

I, authorise

to act on my behalf and access and discuss with the University my: application academic records financial records
I agree not to hold the University responsible nor liable for the actions of the authorised Agent of person. I understand that I may terminate
this Authority to Act.

APPLICANT’S SIGNATURE PERSON OR AGENT’S SIGNATURE (Agent’s stamp)

Signature Signature

Date (dd/mm/yyyy) – – Date (dd/mm/yyyy) – –

Relationship to applicant
Date of Birth (dd/mm/yyyy) – –

Agency Assistance – This section is to be completed ONLY if you have utilised the service of a registered education agency or authorised
representative of Notre Dame.

Agency name Agent’s name

Agency email Agency telephone number

THE UNIVERSIT Y OF NOTRE DAME AUSTR ALIA – INTERNATIONAL APPLICATION FOR ADMISSION CONTINUED OVERLE AF
PART B
PAGE 3 OF 6

Genuine Temporary Entrant (GTE) Assessment

This form is a tool intended to assist international students and their agents to demonstrate that the applicant meets the Australian
Government’s Genuine Temporary Entrant (GTE) criteria. It is designed to manage the immigration risk of the University’s students and
prospective students, and based on information published by the Australian Department of Home Affairs.
The form should be completed correctly by the applicant as well as the education agent (if the student is using an agent) and all
required documentation should be attached. For further information visit: https://immi.homeaffairs.gov.au/visas/getting-a-visa/visa-
listing/student-500/genuine-temporary-entrant.
If you intend to commence at Notre Dame as a non-student visa holder please continue to PART C of the application.

5. VISA DETAILS

5.1 Australian Visa details

Do you currently hold an Australian visa? Yes No – If yes, please provide copies of your current visa as part of your application.

Have you or have any of your dependants breached a condition of a visa, been refused a visa, had a visa cancelled or been removed
or deported from any country including Australia for any reason? Yes No

If so, which country, when and for what reason? Please attach refusal/cancellation letter/s.

5.2 Dependants
What is your relationship status? Single Engaged Married/De Facto Divorced/Widowed

If in a relationship, what is your spouse’s occupation?

Do you have any dependants? Yes No – If yes, how many?

Will you be accompanied to Australia by: i. School children (aged 5-16 years) Yes No – If yes, how many?
ii. Spouse Yes No
Student dependants cannot enrol in a government school unless they meet the criteria set by the Department of Education in your State. You must
otherwise enrol your dependants in a registered non-government school. For more information see notredame.edu.au/international/moving-to-australia.
Please contact the International Office if you will be accompanied by any school-aged children.

6. CHOICE OF EDUCATION PROVIDER/FUTURE BENEFITS

Is there a similar program available to study in your home country? Yes No

Why are you applying to Notre Dame in your degree of interest?

How many years since you last studied?

If there is a gap (one or more years) in between your studies, please explain what you were doing in this time.

What employment opportunities are available in your home country for someone with the qualifications you are seeking?

THE UNIVERSIT Y OF NOTRE DAME AUSTR ALIA – INTERNATIONAL APPLICATION FOR ADMISSION CONTINUED OVERLE AF
 PAGE 4 OF 6

7. FUNDING YOUR STUDIES

7.1 What are the expected expenses for tuition fees for the entire duration of your program?
Do you have access to sufficient funds to support you (and your dependants, if applicable) for your total time studying in Australia
(living costs and tuition fees)? Yes No
Are you aware of the working restrictions whilst studying full-time in Australia? Yes No
Who will be paying for your studies and living expenses while in Australia? (Please provide evidence of the payee’s income or approved bank loan.)

7.2 Sponsorship information (Sponsored applicants only)

Do you already have a sponsor/scholarship from an organisation or government? Yes No
If you do not have a sponsor/scholarship, do you intend to apply for a scholarship? Yes No

Sponsor/scholarship name Country

Email

NB: If your sponsor fails to fulfil its financial obligations, you will be liable for any outstanding fees, charges, debts or any other specified amount
properly incurred. Please attach copies of letter of guarantee documents from your sponsor (if available) and/or copies of any scholarship letters.

8. HEALTH INSURANCE

Overseas Student Health Cover – Do you have existing Overseas Student Health Cover (OSHC)? Yes No

If yes: Name of insurance provider

Insurance policy number | Valid from:

to:
D D
D D
–

–
M M
M M
–

–
Y Y Y Y
Y Y Y Y

If no: Type of cover required: Single Couple Family

Please note: if you do not have existing OSHC with an existing provider for the duration of your program The University of Notre Dame Australia will
organise this on your behalf after payment has been received.

9. CONNECTION TO AUSTRALIA

If you have any relatives in Australia, please complete the following:

Name

Relationship to you (e.g. brother) Immigration status

Address

Town/suburb State Postcode

What type of accommodation do you intend to live in while studying at Notre Dame? (See pages 24–25 for accommodation information).
Homestay With a relative With a friend On-Campus accommodation (Fremantle only)
External student accommodation Shared accommodation
Other (please specify)

If you have pre-arranged accommodation, please list the address.

Address

Town/suburb State Postcode

Do you have any family or business obligations in your home country (e.g. family, business, etc.)? Yes No If yes, please provide details.

THE UNIVERSIT Y OF NOTRE DAME AUSTR ALIA – INTERNATIONAL APPLICATION FOR ADMISSION CONTINUED OVERLE AF
PART C
PAGE 5 OF 6

Research applicants
If you are applying for a non-award, undergraduate or postgraduate coursework program, please continue to PART D

10. RESEARCH APPLICANTS ONLY

Please state the discipline in which you propose to undertake research

Are you intending on residing in Australia to pursue your postgraduate research degree? Yes No
Have you attached an initial research proposal? (See point 10 of the application instructions at the back of this form) Yes No
Have you made contact with a potential research supervisor? No Yes: Name

Background in research
Did any of your employment involve significant research work, the results of which can be verified by an employer? Yes No
If yes, you will need to provide at least two written references to verify this, along with the contact details of the person writing the reference.
Please describe any theses you have successfully completed as part of previous study programs – for the section ‘percentage (%) of degree’,
please use your transcript to calculate the number of credit points used in the thesis component as a percentage of the total number of credit points for the
program. e.g. a Master’s by Coursework with a thesis component of 48 credit points out of 144 credit points would be calculated at a percentage of 33.3%.

Degree name Institution name Title of thesis Word length % of degree Year completed

_________________________ _________________________ ___________________________________

_________________________ _________________________ ___________________________________

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THE UNIVERSIT Y OF NOTRE DAME AUSTR ALIA – INTERNATIONAL APPLICATION FOR ADMISSION
PART D
PAGE 6 OF 6

Declarations and checklist

11. CHARACTER DECLARATION

Have you ever been convicted of a criminal offence? Yes No The disclosure of previous criminal offences will be treated in strict confidence.

12. DOCUMENTATION CHECKLIST

Please attach the following documentation in support of your application. Where the documentation is not applicable to your
situation, mark N/A.
Yes N/A Certified/notarised
 transcripts and certificates of completion together with certified/notarised English translations of all
academic studies undertaken (including studies not completed).
Yes N/A Certified/notarised
 documentary evidence of English language proficiency applicable to your chosen program of study
(see notredame.edu.au/international/how-to-apply)
Yes N/A Certified copies of electronic Confirmations of Enrolment issued from other Australian educational institutions.
Yes N/A Certified copies of personal details and photo pages of passport.
Yes N/A Certified copy of Australian Visa page of passport or Visa Grant Notice.
Yes N/A Certified copy of existing overseas student health cover (OSHC).
Yes N/A Curriculum vitae.
Yes N/A Any previous visa refusal or cancellation letters.
Yes N/A Evidence
 of your ability to pay tuition fees and living expenses while in Australia, such as payee’s income or approved
bank loan, which may include:

• Bank statements from the past six months. The source of any • Employment certificate with salary information
recent lump sum deposits needs to be explained and documented. • Business registration certificate (if applicable).
• Bank loan – the loan letter must state the source and owner of • Financial sponsorship declaration
the collateral used to secure the loan plus the length of loan
and monthly repayments. • Proof of relationship with the sponsor.

Yes N/A Copy of any scholarship letter(s).

Yes N/A I f your name differs from that on any of your supporting documentation: Proof of your change of name
(e.g. marriage certificate, change of name certificate, etc.).
Yes N/A Research applicants only: An initial research proposal (see point 10 of “How to complete the application form”).
Yes N/A I f applicable; at least two written references from your employment verifying any significant research work
completed as part of your work experience, including the contact details of the person writing the reference.

13. APPLICANT DECLARATION – I declare that:

• I am aware of the tuition and living costs of my stay in Australia • I understand that the information provided by me in relation
and have financial capacity to meet such costs for the duration to this application will be provided by the University to the
of my course. I will make timely payments of any fees or Department of Home Affairs for the purpose of assessing and
associated costs. determining my student visa.
• I have read and understood the information published by the • I declare that the information in this application and the supporting
University relating to my selected program, the application documentation is true and correct. I acknowledge and accept
procedures, fees, overseas student health cover, refund policy that the provision of incorrect, false or fraudulent information
and privacy policy. and documentation or the withholding of relevant information
• I authorise the University to audit my application by obtaining or documentation, relating to this application may result in the
official records from any previous institution I have attended University cancelling any offer of enrolment or actual enrolment.
and conducting any other enquiries to verify documents • I understand that where the University detects fraudulent
provided by me or referred to in my application, including information or documentation has been provided in relation to
evidence of English language proficiency and referee reports. my application this will be reported to the Department of Home
If requested by the University I agree to provide original and Affairs and any other relevant statutory authority.
certified copies of documents to support my application.
• I understand that if I accept an offer of admission, I am required to I have read, understand and agree to all of the statements
complete a minimum of six months study in my enrolled program. made above.

Signature Date – – (dd/mm/yyyy)

INCOMPLETE APPLICATIONS WILL CAUSE A DEL AY IN PROCESSING TIME

ND4822 / 15/04/2020 / CRICOS PROVIDER CODE: 01032F

How to complete the application form
NOTRE DAME APPLICATION FORM — PART A

1. APPLICANT TYPE 2.6 Please indicate whether you have 3.2 Please provide details of
Indicate the type of program you any medical or special needs. any current and/or previous
are applying for. Disclosing this information will education, including high school,
not affect your admission to the vocational, college and/or
2. YOUR DETAILS University. university. These details will be
2.1 Indicate whether you have If relevant, successful applicants used to assess your eligibility for
previously studied at The will be informed of services and your preferred program of study.
University of Notre Dame support available through the If so, provide details and copies
Australia and provide your University’s Disability Support of any currently held electronic
student number if applicable. Officer. Your privacy and Confirmations of Enrolment.
2.2 Please provide your details as confidentiality will be respected 3.3 Please select the means by
listed. Print your name clearly and your personal information which you will demonstrate a
in block letters. If your name will be managed in line with the sufficient level of English to
differs from that on any of your University’s Privacy Policy. While study in your preferred program.
supporting documentation, you disclosure is voluntary, if you do Please attach a certified copy of
are required to provide proof not advise the University of your results from an approved English
of the change (for example, requirements before commencing test or transcripts from relevant
marriage certificate or change of your studies, there may be a study. Further information on
name certificate). delay in making arrangements to recognised English proficiency
meet your needs. tests, minimum scores, and study
Applicants under the age of 18 at
that can be used to demonstrate
the time of offer should be aware 3. APPLICATION TO STUDY English proficiency can be
that an electronic Confirmation of 3.1 Please indicate the Campus you found at notredame.edu.au/
Enrolment will not be issued until would like to study at. Include international/how-to-apply.
the applicant turns 18, except the program and program code
in the case of packaged offers (ND Code) that you wish to 4. DECLARATION OF
made in conjunction with an apply for. You can include up to AUTHORISATION TO ACT ON
approved provider. three program preferences, with YOUR BEHALF
2.3 Please provide the details your most preferred program If you are utilising the service of an
of your address and contact as preference 1. Please also education agency, please provide
details in your home country and indicate the commencement year your agent’s details. If applicable,
notification address for ongoing and semester for which you are the specified agency/agent will be
correspondence (in Australia or applying, taking into consideration authorised to access and discuss
your home country). the application due dates and your application for admission
2.4 Please provide your current commencement dates for each and your academic record to
passport and citizenship details. semester see: notredame.edu.au/ The University of Notre Dame
international/how-to-apply. Australia with University staff. This
2.5 Please indicate languages
authorisation will be applicable
spoken at home in order of use.
for the duration of the application
process and, if applicable, the
duration of your studies at Notre
Dame unless otherwise directed
by the applicant.

GENUINE TEMPORARY ENTRANT (GTE) ASSESSMENT — PART B

For further information on the purpose of the Genuine Temporary Entrant Assessment visit: https://immi.homeaffairs.gov.au/visas/
getting-a-visa/visa-listing/student-500/genuine-temporary-entrant.

5. VISA DETAILS 6. CHOICE OF EDUCATION • P

 lease indicate how many years
5.1 Please indicate if you currently hold PROVIDER/ FUTURE BENEFITS have passed since you last
an Australian visa and, if so, provide • P
 lease explain why you have studied (at high school, vocational
details. Indicate if you or your chosen to study at Notre Dame, training or university). If there
dependants have ever breached a rather than at another university is a gap (one or more years) in
condition of a visa, been refused a either in your home country, between your studies, please
visa, had a visa cancelled or been another country or Australia. explain why there has been a gap
removed or deported from any Explain why you have chosen the in your studies (e.g. employment,
country including Australia for any Sydney or Fremantle Campus. family commitments, etc.) and
reason and, if so, provide details. Please also indicate if there is a why you wish to study again now.
5.2 Please indicate your relationship program similar to the one you • Please outline your future career
status and whether you will be are applying to study at Notre plans and the employment
accompanied by your spouse Dame which is available to study opportunities in your home
and/or any school children. For in your home country. If so, please country for someone with the
further information on schooling explain why you have chosen to qualification you are seeking to
for dependants, see notredame. study in Australia at Notre Dame undertake at Notre Dame.
edu.au/international/moving-to- rather than in your home country.
australia.
GENUINE TEMPORARY ENTRANT (GTE) ASSESSMENT — PART B (CONTINUED)

7. FUNDING YOUR STUDIES any scholarships. Evidence of copy of your OSHC card with the
7.1 P
 lease specify your expected payee’s income, employment, application.
tuition fees for your studies for financial sponsorship and/or If you do not have existing OSHC,
the entire duration of the program any scholarships will need to be please indicate the type of cover
(i.e. annual tuition fee multiplied provided. required.
by the duration of the program). 7.2 Where relevant, please provide
details of any sponsorship or 9. CONNECTION TO AUSTRALIA
Please indicate whether you
have access to sufficient funds scholarships you have obtained • If you have any relatives in
to support yourself and any or for which you intend to apply. Australia, please provide details.
dependants for the duration of 8. HEALTH INSURANCE • P
 lease indicate where you intend
your studies in Australia and to live when you are in Australia.
whether you are aware of the Please indicate whether you have
existing OSHC (Australian Health • O
 utline any ties you have to your
working restrictions for student home country (e.g. family living
visa holders in Australia. Insurance). If yes, please indicate
the provider, the policy number at home, employment, business
Outline who will be funding and the expiry date of the cover. opportunities, etc.).
your studies in Australia and If applicable, attach a certified
whether you are the recipient of

RESEARCH APPLICANTS ONLY — PART C

10. RESEARCH APPLICANTS significant research experience, This should include how you
If you are applying for a Research you will need to include two written plan to undertake the project,
program (i.e. Master of Philosophy, references (one page) to verify and analyse your findings.
Master’s by Research, Doctor this experience. Please include Where possible, list potential
of Philosophy or Professional the name, professional position, supervisors and indicate if you
Doctorate), please refer to email address and telephone have had contact with them.
research instructions on website: number of each referee and Additionally, please include
notredame.edu.au/__data/assets/ indicate their relationship to you. a description of any research
pdf_file/0017/45305/How-to- Please prepare an initial research projects you have undertaken
Apply-for-Admission-to-a-Higher- proposal, of approximately in academic or professional
Degree-by-Research.pdf. one page in length, outlining contexts, and details of any
your planned area of research. resulting publications.
If your employment has involved

DECLARATIONS & DOCUMENTATION CHECKLIST — PART D

11. CHARACTER DECLARATION or Public Notary. Documents

Please indicate whether you have can also be certified by one of
been convicted of a criminal Notre Dame’s contracted agent
offence. This information will be partners (see notredame.edu.au/
treated in the strictest confidence. international/agents).
Certified translations completed by
12. DOCUMENTATION CHECKLIST a National Accreditation Authority
Please tick the checklist to for Translators and Interpreters
ensure your application form (NAATI) translator should be
and documents are complete. If provided for qualifications written
the listed documentation is not in a language other than English.
applicable to your application, tick Both the certified translation and
the N/A (Not Applicable) column. a certified copy of the original
You may obtain certification of document should be attached to
documents by presenting both the application.
the original documents and 13. APPLICANT DECLARATION
photocopies of these documents
to a certifying agent. Overseas, Please complete the declaration,
certifying agents include: having read all information on
Australian Consular official, High the form. Applications will not be
Commission or Trade official, processed without a signature.