Expression of Interest

Please fill the form for further information

Personal Detail

Name (required)

Date of Birth (required)

Nationality (required)

Sex (Male / Female)
FemaleMale

Country of Birth

Mobile Phone (required)

Email (required)

Postal Address

Country

Postcode

Telp:

Fax
Home Address

Country

Postcode

Telp:

Fax

Parent/Guardian Name (required)

Email

Mobile Phone (required)

Background Information

Have You previously applied to another Foundation/Degree Program
YesNo

If "Yes", please provide detail :

The application form is submitted by : (select one)
Self (direct applicant)GEI registered agentOther(friend/family)-fill the column below

GEI Registered agent name:

Specify applicant relation:

Intake and Program Details

Please indicate which intake and foundation/degree program you are applying for:

Please indicate what date you would like to commence ( 2018 )

Qualification

School/Institution Name:

City:

Year/Level:
Country:

Discipline:

Declaration and Signature

I declare the information provided as part of this expression of interest is true and accurate at the time of submission. This is provided on voluntary basis, and is for the purpose of applying for entry to GlobalJaya Edukasi Indonesia or Swinburne University of Technology educational program.

The disclosure of this information will only be used in accordance for the verification and confirmation of the details you have provided, in line with your expression of interest for entry into the above mentioned programs.

I acknowledge that certified copies of documents related to this expression of interest must be provided. Without documentary evidence to support this expression of interest, no admission or approval of entry into program can occur.

I acknowledge and confirm that I have the ability to meet the tuition fee and living expenses necessary to participate in this program.

I give consent to GlobalJaya Edukasi Indonesia to send me marketing related information about educational programs being offered.

Thank You for Joining us. We will contact you for the rest of Documents

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