APPLICATION FORM

Application ID

1 Personal information
Have you previously applied for a place or been enrolled in a program at RMIT?
Yes Student ID

Please fill in your family name, middle name(s) and given name as Date of birth (dd/mm/yyyy)
stated in your ID card/passport
Family name

Middle name(s) Gender

Given name Male Female Other

Nationality
Vietnamese Other (please specify)

2 Contact information
Permanent home address Postal adress As permanent home address
House number and street name House number and street name

Ward Ward
District or town District or town
Province or city Province or city

Personal contact details

Mobile Occupation
Home phone Company
Email

Family contact details

I agree for RMIT to contact the below nominee: In an emergency Release of study progress
Contact’s full name
Relationship Occupation
Mobile Email

In case of emergency, please specify which hospital should be chosen (tick ONE box only)
Hospital designated by Student preference (please indicate hospital)
campus medical clinic

3 Academic records
College or university
Program name
Program level Study location
Completed Duration from (mm/yyyy) to (mm/yyyy)

Other college or university

Program name
Program level Study location
Completed Duration from (mm/yyyy) to (mm/yyyy)

Other college or university

Program name
Program level Study location
Completed Duration from (mm/yyyy) to (mm/yyyy)

Have you previously been expelled from RMIT Vietnam or any other college or university? (leave blank if not applicable)
Yes College or university
Reason
 4 Registration for English program (for non-native English speakers)
Your most recent English language certificate
Test date Result

Register for English for University IELTS Test Preparation

Level Commencement date

5 Registration for postgraduate program

Program Campus Semester
Master of Business Administration Saigon South Feb 20
Master of Business Administration (Executive) Hanoi City Jun 20
Master of International Business Oct 20
Graduate Certificate in Business Startups

6 Special offer
Family discount (5%)* Alumni discount (10%) for RMIT Vietnam or any Australian universities
Family member’s student ID Program completed
*Applicant must provide notarised copy of birth certificate/marriage certificate. Campus

Fixed fee (applicant will have to submit a seperate form)

7 Equitable Learning service

RMIT Vietnam is committed to providing an accessible and supportive learning environment for all students. If you have special requirements,
please indicate the type of support you need below:
Hearing Mobility Medical Learning

Vision Other (please specify)

8 Applicant declaration

Please read and sign the following declaration. This application is not valid unless signed and dated.

I declare that, to the best of my knowledge, the information supplied in this application and supporting documentation is correct and complete. I will
notify RMIT Vietnam immediately of any change to my personal details.

I acknowledge that the provision of incorrect information or the withholding of information or documentation relating to my application may result in
the cancellation of any offer or enrolment by the University.

I understand that the release form allows information, including my personal details and information about my academic and financial records, to
be released.

This permission is granted provided the University releases information only for the reason(s) nominated and only after proper identification has
been made.

I understand that RMIT Vietnam may be required to release information about my status as a student to other bodies as part of its legal requirements
within Vietnam and Australia.

I understand that RMIT Vietnam reserves the right to discontinue or alter any program, course/subject, fee, admission requirement, staffing or other
arrangement without prior notice.

Applicant’s signature

Full name

Date (dd/mm/yyyy)

FOR OFFICE USE ONLY (Applicant does not fill in this section) Selection officer’s Approval
Unconditional Conditional on English
Other
Received by PA on Received by Admissions on Received by selection officer on

PA’s stamp and signature Admissions’ stamp and signature Selection officer’s stamp and signature