Personal Details
Mr
Ms
Family name:
*
Given names:
*
Place and date of birth:
date month year
*
Nationality
*
Parent/Guardian:
*
Contact Details
Correspondence/Mailing Address/Town/State/Country:
*
Postal Code:
*
Telephone:
*
Fax:
Mobile Phone:
*
Email:
*
Course Selection
* Please indicate which course you are applying for:
Pre-university Level
International foundation program (IFP)
University Level:
Commerce
Management
Computing
Media and communication
Course Commencement
Please specify the semester in which you wish to begin
your studies.
Year: March
June October
*
English Proficiency
For non-native speakers of English only.
IELTS Score:
TOEFL Score:
IBT Score:
Others:
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Academic Qualifications
Name of qualification:
*
School Attended:
*
Town/State/Country:
*
Year Awarded:
*
Language of instruction:
*
Include copies of academic qualifications or school report
and your latest photograph into one zip file.
*
How Did You First Learn About MIBT Indonesia?
Exhibition/Seminar
Newspaper/Magazine
Website
Recommended by a friend or relative
Banner/Sign Board/Direct Mail
School
Education Agent (please specify):
Other (please specify):
Declaration
I declare that the information I have supplied on this
form is to the best of my understanding and belief complete
and correct. I understand that the giving of false or incomplete
information may lead to the refusal of my application or
cancellation of enrollment. I give permission to obtain
official records from any educational institution attended
by me. I also authorize Melbourne Institute of Business
and Technology Indonesia to supply any relevant official
records to educational Institutions to which I am seeking
admission and to government bodies. I also understand that
fees may increase. I accept the liability for payment of
all fees as explained in the MIBT Indonesia brochure.
Click
here to read the fees and conditions of enrollment
* I have read and understood the fees and conditions of
enrollment.
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