1. PERSONAL DETAILS
   
Family name:
   
Given names:
   
Sex:
Male Female
   
Date of birth:
[Day/Month/Year]
   
Nationality:
   
Passport Number:
   
Address 
[home country]: 
   
Country of Birth:
   
Language spoken 
at home:
   
Telephone:
   
Fax:
   
E-mail:
   
Address in Australia 
[if known]:
   
Telephone:
   
Fax:
   
Occupation:
   
Visa type: 
   
Where did you 
hear about ACE? 
   
   
2. COURSE REQUEST
   
Standard Courses: 
   
Exam Courses: 
 
Special Programs: 
 
Course Start date: 
[Day/Month/Year]
   
Total number 
of weeks: 
   
   
   
3. CAMPUS REQUEST
   
 

Which ACE campus 
would you like to study at?

 
   
[Please note that not all courses are offered at all ACE campuses]
 
   
   
   
4. ACCOMMODATION REQUEST
   
   
Do you want ACE to organise accommodation for you?
  Yes No
   
[If you answered 'No' to the previous question, please proceed to Section 7]
   
   
If you would like ACE to organise accommodation for you, please choose from these accommodation options:
 
   
Type of room:
 
   
Start date:
  [Day/Month/Year]
   
End date:
  [Day/Month/Year]
   
Total number of weeks/days:
 
   
Airport transfer required on arrival? 
   Yes No
   
Flight number:
 
   
Flight arrival date:
 
   
Flight arrival time:
  
   
   
[If you have requested 'Homestay Accommodation' from the accommodation choices above, please complete the section 'HOMESTAY PREFERENCES' below. If not, please proceed to Section 7.]
   
   
   
5. HOMESTAY PREFERENCES
   
Do you smoke?
  Yes No
   
Will you allow smoking in the house?
  Yes No
   
Do you prefer a household with pets?
  Yes No
   
Do you have any allergies?
  Yes No

If you answered 'yes' to the question above, please give details of your allergies:
   
Are there any foods
you cannot eat?
  Yes No

If you answered 'yes' to the question above, please give details of the foods you don't like:
   
Do you have any
medical conditions?
  Yes No

If you answered 'yes' to the question above, please give details of your medical conditions:
   
Do you prefer living 
in a household with young children?
  Yes No I don't mind
   
Do you have any special requests?
  Yes No

If you answered 'yes' to the question above, please give details of your special requests:
   
   
   
   
6. AGENT DETAILS [to be filled in only by agents enrolling students on-line]
 
 
Agent name:
 
   
Agent contact address:
 
   
Agent e-mail address:
 
   
Agent fax number:
 
   
Name of contact person in agency:
 
   
   
 
7. DECLARATION
 
[Please tick] I have read, understand and accept the terms and conditions of enrolment of the Australian College of English and hereby authorise the College to apply the monies payable by me in accordance with the same.