Preliminary Application - JAPAN

Eligibility Criteria

Before completing this form you must meet the following criteria:

Australian Citizen or Permanent Resident.
Have completed grades 9, 10, 11, or 12* & will be aged 15-18 by the date of departure.
(*Due to Department of Education reciprocity regulations in Victoria & ACT students completing grade 12 are ineligible to apply for our program)
*Students in QLD, NSW, TAS, NT, WA currently completing Yr 12 are only eligible for the March Program.
Have maintained average or above grades for the past 3 years.
Have studied the Japanese language in high school for a minimum of 1 year.

Students from outside of Australia are ineligible to apply.

Please note:

If you meet our initial eligibility criteria, you will receive a full application booklet within a few days.

If you do not meet our initial eligibility criteria, you will receive an email to this effect shortly.

If you have not received an application booklet or an email within 5 working days, please email This e-mail address is being protected from spam bots, you need JavaScript enabled to view it


PERSONAL INFORMATION


First Name *

Last Name *

Address *

Suburb *

State *

Post Code *

Home Phone *

Mobile Phone

Email *

Age *

Date of Birth *

Gender *	Male Female

Australian Citizen *	Yes No Permanent Resident


FAMILY INFORMATION


Father's name *

Father's Occupation *

Mother's name *

Mother's Occupation *

Other family members living with you		Please include Name, Relationship and Age for each


SCHOOL INFORMATION


Name *

Address *

Suburb *

State *

Post Code *

Phone *

Fax *

Principal's Name *

Current Year Level *


Please record your most recent academic results in each subject you study


English *

Maths *

Japanese *

Number of Years studied Japanese in High School *		include this year.

Other foreign languages studied and duration. *

Other Subjects & Results *		list all your other subjects and most recent result in each subject eg Science A, Drama B+


GENERAL INFORMATION


I am applying for the following Program: *	10 Month AYP Program 5 Month Semester Program	choose 1 only

Departure Date *	March 2011 August 2011	Choose 1 only. New price applies from 2011.

I first learned about the AIIU High School Abroad program from *	Career Expo Friend Internet Search Newspaper Past Participant School Teacher Other

Have you consulted a medical specialist in the last 3 years? *	No Yes If Yes, please tick relevant issues below Ongoing or serious health issues Mental health issues anorexia bulimia anxiety depression bullying

Are you taking any medications in relation to the above?		Please provide details of your health issue and medication.

Would your family be willing to host someone whilst you were overseas?	Yes No

If not, do you have a relative or friend willing to host?	Yes No

I feel I would benefit from participating in the AIIU High School Abroad Program because *

Preferred City for Interview *

How long will it take you to travel to your Preferred City for Interview *		To assist AIIU with allocating your interview time

City for Interview, second choice *		If insufficient number of applicants from your closest city you may be required to travel to your second choice.

I declare that the information I have provided on this form is true and correct *	Yes No