Nexus College - Online Registration Form

Nexus College Centre

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Online Registration Form

Please fill up this online form to register with Nexus College.

Personal Details

Family Name*
Given Name*
Preferred Name
Gender	Male Female
Age
Date of Birth
Nationality
Country of Birth
Are you a permanent resident of Australia?	Yes No
Passport Number*
Country of Issue
Type of Visa	Tourist Student Other
Visa Expire Date*
Do you have OSHC(Overseas Student Health Cover)?	Yes	No
Do you have OSHC(Overseas Student Health Cover)?	OSHC No. OSHC Provider	I require Single Cover Family Cover

Contact Details

Overseas Address
Australian Address
Telephone Number
Mobile phone Number
E-mail Address*

English Level

Years studied English
Years of Education Conducted in English medium
Previous English Exam Results	TOEFL IELTS OTHER

Accommodation Details

If you require our homestay service, please fill in the following sections
Do you wish Nexus to arrange homestay accommodation?	Yes No
Number of weeks for homestay
Types of homestay	Single Homestay Share homestay Hotel Backpackers
Do you smoke?	Yes No
Would you prefer a homestay with pets?	Yes No
Do you have any allergies?	Yes No
Do you have any special dietary requirements?	Yes No
Do you require airport pickup service?	Yes No
If you require our airport pickup service, please fill in the following sections
Arrival date and time
Flight Number

Course Details

Course selection	Intensive English IELTS Preparation Other language course
Starting Date
Finishing Date
No. of weeks apply for

How Did You Hear About Nexus College

Community
Newspaper/Magazine
Friends
Internet
Other

Agreement

Agreement space goes here

I agree to the above terms