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)
Have maintained average or above grades for the past 3 years.
Have studied the Japanese language for a minimum of 1 year.

Student from outside of Australia are ineligible to apply.


PERSONAL INFORMATION


First Name *

Last Name *

Address *

Suburb *

State *

Post Code *

Phone *

Email *

Age *

Date of Birth *

Sex *	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 *

Grade in 2008 *

What foreign languages have you studied, and for how many years? *


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


English *

Maths *

Languages *

Other


GENERAL INFORMATION


I am applying for the following Program: *	10 Month AYP Program 5 Month Semester Program 3 Month Term Program	choose 1 only

Departure Date *	August 2009 March 2010	Choose 1 only

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 health professional in the last 5 years for	Ongoing or serious health issues Mental health issues	We will contact you shortly for more information if you have.

Are you taking any medications in relation to the above?		If yes, please provide details.

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 *

Travelling Time to Preferred City for Interview *		To assist with preparing interview schedule

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

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Preliminary Application - JAPAN

Eligibility Criteria

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