Viva College Online Enrolment form

Personal Email:

An email will be sent to the above address to confirm your enrolment. Please make sure it is the email address you wish to use in your communication with Viva College

First Name:

Family Name:

DoB(day/month/year):

Gender:

Male
Female

Country of Citizenship:

Passport Number:

Country of Passport (if different):

Visa Applying from:

Visa Type:

DIAC office:

Health Insurance:

(Student Visa Only)

I require Overseas Student Health Cover for:
Single Person
Family
I have already purchased health cover
None required

Date of Arrival:

OSHC Start date:

Postal Address:

Do you suffer from any allergies or health problems?:

(please specify)

Facsimile:

Preferred Contact Method:

Address:

Suburb/City:

State:

Postode:

Telephone:

Facsimile:

Agent Details:

I am enrolling direct
I am using an Agent

Company name (if applicable:

Counsellor name (if applicable):

Counsellor email (if applicable):

Focus English (Intensive English Language) - CRICOS code 061036E:

Day
Night

Length in weeks:

IELTS Preparation - CRICOS Code 061049M:

Day
Night

Length in Weeks::

EAP (English for Academic Purposes) - CRICOS code 061035F:

Day

Length in weeks:

FCE (Cambridge First Certificate Preparation:

Day (Please note set start dates on academic calendar)
Night (Please note set start dates on academic calendar)

Smart Talk - CRICOS Code 061055B:

Day

Length in weeks:

English for Teaching Children (EFTC)- CRICOS Code 061057M:

Day

Certificate IV in TESOL - 30920QLD - CRICOS code 073618F:

Day

Certificate II in Business - BSB20107 - CRICOS code 065016K:

Day
Night

Certificate II in Customer Contact - BSB20207 - CRICOS code 073721G:

Afternoon and evening
Day

Certificate III in Business Administration - BSB30407 - CRICOS code 068405F:

Day
Night

Certificate IV in Business - BSB40207 - CRICOS code 073722F:

Day

Diploma of Business - BSB50207 - CRICOS code 074101E:

Day

Viva Plus:

I will sign up at Reception

Number of sessions:

Homestay Required:

Yes
No

Payment Plan Required:

Yes (There is a $220 admin fee for payment plans)
No

First Course Start Date:

Second Course Start Date:

Departure Flight Time:

Departure Flight Date:

Departure Flight Number:

What are your favourite hobbies?:

Arrival Flight Number:

Arrival Flight Date:

Arrival Flight Time:

Are children OK in your homestay?:

Yes
No

Do you suffer from any other allergies? (please specify):

Are pets OK in your homestay?:

Yes
No

Do you suffer any food allergies? (please specify):

Please list any foods that you cannot eat:

Please list any dietary requirements:

Do you smoke?:

List any other special requirements:

Personal Details

Contact Details (optional)

Australian Address (if known)

Agent Details

Choose your Course(s)

Do your require Homestay?

Start date(s) and payment

Additional Information