A+J SCS | Student Application Form

Institution/School & Course Details

Educational Inst.

Educational Inst. alt

Write here your Educational Institution if not listed above.

Course*

Student ID Number*

Commencement*

Format: YYYY-MM-DD

Student Details

Title

Family Name*

Given Name*

Date of Birth*

Format: YYYY-MM-DD

Country of Origin

Passport Number*

Email*

Valid email address only

Parents Detail - Father

Family Name

Given Name

Address

Telephone (Home)

Including country and area code

Telephone (Work)

Including country and area code

Mobile Phone

Including country and area code

Parents Detail - Mother

Family Name

Given Name

Address

Telephone (Home)

Including country and area code

Telephone (Work)

Including country and area code

Mobile Phone

Including country and area code

Other Info

Health/Medical Condition

Other

Any other information you think will assist us in caring for your child

Language Spoken

Agent Detail

Agent Name

Please complete the form bellow if you couldn't find your agent in the list.

Company Name

Company Status

eg. Head Office, Branch Office

Country

Address

Telephone

Including country and area code

Contact Person

I declare that the information given in this application is true and correct.