Genuine Student Evaluation Form

The purpose of this form is to enable the University to make an assessment of the genuineness of an applicant’s intention to complete
their studies at The University of Western Australia. Each section is targeting a specific area on which UWA will base its assessment, and
in which the Department of Home Affairs may be interested in during your visa application. Please note that in addition to completing
this form you may be contacted by the University for an interview or clarification on any information provided.

You must answer all questions in full. Failure to complete any answers may result in your application being rejected.

All answers must be your own and you cannot seek assistance from others. This includes migration agents and UWA staff
members.

Providing false or misleading information is a serious offence under Australian law. If any information on the form is found to be
incorrect this will result in your application being rejected and/or your enrolment being discontinued.

Personal Details

Student ID: Date of Birth:

Given Name:

Family Name:

Gender:

Mobile Number:

Email Address:

Home Address:

Country of Citizenship:

Passport Number:

Course Applied for:

Commencement:

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 Agent Details

Are you using an agent to assist you in your visa application?

[ ] Yes If yes, please provide the name of the agent:_________________________________________________________

[ ] No If no, please provide the reasons below as to why you are not using an agent:

Section A: Study Choices

A1: Please list all applications to other Australian education providers you have submitted. Please list the CoEs (where relevant). If you
have not submitted any other application to other Australian education providers, please indicate so.

[ ] I have not submitted any other applications to Australian education providers.

Institution Course Confirmation of Enrolment Reason for not accepting

(CoE)

A2: Have you ever enrolled in a course at an institution and not graduated?

[ ] No [ ] Yes If yes, please indicate the reason for non-completion. Please indicate if you were excluded or
expelled, and if you chose to discontinue your studies, please indicate the reason for doing
so.

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 A3: Please explain all gaps in your studies. These are periods where you were not studying, where the gap is longer than three months.

A4: Why have you chosen to study the course specified on your application?

A5: Why have you chosen to study in Australia and not your home country?

A6: Why have you chosen to study in Perth?

A7: Why have you chosen to study at UWA?

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 A8: (Postgraduate applications only) Is this course in a different area of study than your previous studies?

[ ] No [ ] Yes If yes, please provide information below on why you have changed your area of study.

A9: What do you know about the academic standards of UWA? What makes you believe you are prepared to study at a highly ranked,
research intensive University?

Section B: Employment and Career

B1: Please attach your Curriculum Vitae / Resume to this application, outlining your work experience to date. If you have not
completed any work experience, please indicate below.

[ ] CV Attached

[ ] No work experience

B2: Please provide your work history from the last 2 years. Please also provide evidence of your employment.

Job Title Employer Monthly Salary (in local Evidence Attached

currency)
[ ] Evidence attached

[ ] Evidence attached

[ ] Evidence attached

B3: How is this course relevant to your future career plans?

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 B4: What position/roles will your studies prepare you for?

Job Title Industry / Field of Work Estimated Monthly Salary (in local
currency)

B5: Are you intending to work in Australia after completing your studies?

[ ] No [ ] Yes If yes, Please indicate how you intend to work in Australia following completion of your
studies. Include what visa you intend to work on and any other relevant information.

Section C: Finance

C1: Please indicate how you will pay for your tuition fees (select all relevant options).

[ ] Sponsorship (please provide a copy of your financial guarantee from your sponsor awarding body)

[ ] Bank Loan (please provide supporting documentation showing evidence of this loan)

[ ] Family / Relative Support (please provide a bank statement showing evidence of available funds)

[ ] Personal Savings (please provide a bank statement showing evidence of available funds)

[ ] Other (please provide details below and attach a bank statement or other evidence)

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 C2: Please indicate how you will pay for your living costs (such as food and rent) while staying in Australia (select all relevant options).

[ ] Sponsorship (please provide a copy of your financial guarantee from your sponsor awarding body)

[ ] Bank Loan (please provide supporting documentation showing evidence of this loan)

[ ] Family / Relative Support (please provide a bank statement showing evidence of available funds)

[ ] Personal Savings (please provide a bank statement showing evidence of available funds)

[ ] Other (please provide details below and attach a bank statement or other evidence)

C3: Are you intending to undertake any part-time work while residing in Australia?

[ ] No [ ] Yes If yes, please provide information below

Type of work you will be applying for: _________________________

Number of hours expected to work per week:________________________

Expected monthly wage (in Australian dollars):___________________

C4: Please indicate your anticipated total costs across the duration of your course, in both Australian currency and your local currency.

Australian Currency Local Currency

Tuition Fees

Health Insurance

Living Costs (includes rent, food, bills,

etc.)
Costs for dependants (such as children
and non –working spouse. Include
school fees for children where
relevant)
TOTAL

C5: Please indicate your intended accommodation arrangements:

[ ] Renting (off campus)

[ ] On campus accommodation

[ ] Living with relative(s)

[ ] Other:___________________________________

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 Section D: Immigration History

D1: Have you ever travelled to Australia before?

[ ] No [ ] Yes If yes, please provide information below

Dates Reason for travel Visa type

D2: Have you ever had an Australian visa application denied or an Australian visa cancelled?

[ ] No [ ] Yes If yes, please attach the rejection/cancellation letter

D3: Have you ever had a visa application denied or cancelled from a country other than Australia?

[ ] No [ ] Yes If yes, please attach the rejection/cancellation letter

D4: Have you ever travelled to the Canada, New Zealand, United Kingdom, or United States of America before?

[ ] No [ ] Yes If yes, please provide information below

Dates Country Reason for travel Visa type

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 Section E: Family

E1: Do you intend to bring any family members to Australia?

[ ] No [ ] Yes If yes please provide details below

Name Date of Birth Relationship to you Passport Number

E2: Are you intending to bring your spouse with you to Australia?

[ ] No [ ] Yes If yes please provide answers below

Please upload a marriage certificate or evidence of partnership.

[ ] Evidence attached.

What will your spouse do while you are studying in Australia?

Has your spouse ever had a visa denied or cancelled to Australia or any other country?

[ ] No [ ] Yes If yes, please attach the rejection/cancellation letter

Has your spouse ever travelled to Australia before?

[ ] No [ ] Yes If yes please provide details below.

Dates Reason for travel Visa type

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 E3: Please list your next of kin/immediate family members and their location:

Name Relationship to you City of Residence Contact details

E4: Do you have any relatives living in Australia?

[ ] No [ ] Yes If yes please provide details below.

Name Relationship to you City of Residence Visa / Australian Citizenship Status

E5: Do any of your relatives live in a city other than in your home country, but not in Perth?

[ ] No [ ] Yes If yes please explain why you have decided not to study in a city or location where you
already have relatives.

Section F: Additional Information

F1: Have you undertaken or will be undertaking any English proficiency tests, such as IELTS, PTE Academic, TOEFL, Cambridge?

[ ] No [ ] Yes If yes please include all tests undertaken in the last two years

Name of Test Date Taken Evidence attached?

[ ] Yes

[ ] Yes

[ ] Yes

[ ] Yes

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 F2: Do you have a criminal record in your home country or any other jurisdiction?

[ ] No [ ] Yes If yes please provide information below and attach all copy of criminal record check or
equivalent.

F3: Are you from a country that has mandatory national or military service?

[ ] No [ ] Yes If yes please answer the follow up questions below.

Have you completed your national or military service?

[ ] Yes Please indicate when you have completed your service:___________________________________

[ ] No Please indicate when you plan to complete your service:___________________________________

[ ] I am exempt from completing national/military service. Please indicate reasons for exemption below

F4: Do you own any property/real estate?

[ ] No [ ] Yes If yes, please provide information below. Please include the address of owned property.

F5: Please indicate any additional information that can be used to verify that you are a genuine temporary entrant. Attach evidence as
appropriate. Refer to https://www.homeaffairs.gov.au/trav/stud/more/genuine-temporary-entrant for further information.

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 Section G: Declarations

G1 I understand my obligation to have sufficient funds to pay for Overseas Student Health Cover, all tuition [ ] Yes [ ] No
fees, student amenities fees and associated student costs and all living and travel expenses for myself and
any dependent/s for the entire duration of my stay in Australia.
G2 I understand that if I am unable to pay my tuition fees in line with the payment due date, UWA will cancel [ ] Yes [ ] No
my enrolment which will affect my student visa.
G3 I understand that while, as part of my student visa, I am allowed to work a maximum of 40 hours per [ ] Yes [ ] No
fortnight (with unlimited work- rights during semester breaks), these funds are to be used to supplement
my living costs but must not be my only source of income to pay my tuition fees.
G4 I understand that my visa may be rejected or cancelled by the Department of Home Affairs if it is [ ] Yes [ ] No
determined that documents supporting my application are fraudulent or I have made a false declaration.
G5 I understand that my visa application will be denied if I do not pass the Department of Home Affairs’ health [ ] Yes [ ] No
and character checks.
G6 I understand that UWA reserves the right to withdraw an accepted offer if evidence becomes available that [ ] Yes [ ] No
the application is not bona fide.
G7 I understand that my visa may be cancelled by the Department of Home Affairs if I do not abide by the [ ] Yes [ ] No
conditions of my visa. Please go to the following link for more information:
http://www.homeaffairs.gov.au/Trav/Stud/More/Visa-conditions/visa-conditions-students
G8 I understand that I will be required to update any changes to my personal details direct to the UWA Student [ ] Yes [ ] No
System within seven days of my arrival in Perth. This includes providing a local phone contact number.
These details will only be passed onto the Department of Home Affairs if requested by them.
G9 I have read and fully understand the UWA Refund Policy. [ ] Yes [ ] No
G10 I have read and fully understand that if I request a transfer to another provider within the first six months [ ] Yes [ ] No
of my study, UWA may refuse my request.
G11 I understand that I may be required to attend an interview to verify any information I have supplied in the [ ] Yes [ ] No
form.
G12 I understand that UWA may contact any of my employers or financial intuitions to verify the information I [ ] Yes [ ] No
have supplied.

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 Student Declaration and Agreement

TRUTH AND ACCURACY

1. I declare that I am a genuine temporary entrant to Australia and genuine student.
2. I declare that all the information I have given in this application is true, correct and complete, and is not false or misleading. I
understand giving false or misleading information is a serious offence under Australian law.
3. I agree that The University of Western Australia (“the University”) can vary or reverse any decision made on the basis of
any incorrect, incomplete, false or misleading information that I have provided. This may result in my enrolment and visa being
terminated.
4. I agree to tell the University immediately if there is any change to the information I have given in this application.

PRIVACY AND DISCLOSURE

5. I understand that the University may obtain official records from my current or previous educational institution or employer.
6. If any organisation is named in documents provided by me as part of my application (e.g. as evidence of my qualifications or work
experience) then I authorise that organisation to release any personal information that it holds about me to the University so that the
University can verify the information I have provided.
7. I authorise the University to release any personal information that it may hold about me to any other educational institution that is
seeking to verify my student conduct or academic record for the purpose of determining my eligibility for admission to, or enrolment at,
that institution.
8. I understand that any information about me that is provided to, or maintained by, the University may be given to Australian
government departments and agencies as required by law. This information includes, but is not limited to, changes to my enrolment
and any breach of a student visa condition relating to attendance or satisfactory academic performance. The University may also provide
relevant information about me to organisations at which I undertake a work placement or practicum as part of my course.
9. If the payment for my course is made by someone else (“sponsor”), I agree to the release of all information to my sponsor regarding
my application and subsequent enrolment including my subject results, progress reports, and enrolment details (including contact
details).
10. If I am under 18 years of age, I consent to the release of information regarding my academic performance and attendance to my
parent(s) and/or guardian(s).

TRANSFER FROM ANOTHER EDUCATION INSTITUTION IN AUSTRALIA

11. I agree to advise the University of any studies that I am undertaking or intend to undertake with another education provider at the
same time that I plan to study at the University. I understand that, in these circumstances, the University cannot to offer me enrolment.
I understand that I must present any documents requested by the University to confirm my status.

FINANCIAL OBLIGATIONS
12. I agree to provide any financial information requested by the University at any time for the purpose of the University assessing my
financial ability to undertake a course of study.
13. I understand that the University will not act as a financial guarantor for me, and I am solely responsible for all expenses incurred by
me and my dependents, including as the result of legal action, while I remain in Australia on a visa issued for the purposes of studying
at the University, whether or not I have completed the course or remain enrolled at the University.

WHILE I AM ENROLLED AT THE UNIVERSITY

14. I agree to be bound by all the rules, regulations, statutes, bylaws and any relevant policies of the University;
15. I must enrol in a study pattern that allows me to complete my course within the course duration set in my Confirmation of Enrolment
(COE);
16. If I am not the holder of a student visa, I understand that it is my responsibility to ensure that the visa I hold permits me to undertake
the course in which I enrol at the University.
17. I understand that I am a full-time student and my attendance will reflect this status

APPLICABLE LAW
18. This declaration and agreement, and the availability of complaints and appeals processes, does not remove my right as a student to
take action under Australia’s consumer protection laws.
19. This declaration and agreement is governed by Western Australian law. I agree to submit to the non-exclusive jurisdiction of the
courts of Western Australia.

Student Signature:__________________________________________________________ Date:_____________

Spouse Signature (if relevant):________________________________________________ Date:_____________

Guardian Signature (if you are under the age of 18):________________________________ Date:_____________

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 Checklist

To submit your Genuine Student Assessment form please follow the instructions on your offer and submit this form along with the
supporting documents below.

[ ] All 12 pages of the form completed

[ ] A copy of your passport

[ ] A copy of your Curriculum Vitae / Resume

[ ] Evidence of your recent employment

[ ] A copy of your sponsorship details (if relevant)

[ ] A copy of your loan details (if relevant)

[ ] A copy of your financial records

[ ] A copy of any visa rejections or cancellation notices

If you are bringing your spouse:

[ ] A copy of your marriage certificate or other evidence of spousal arrangement

[ ] A copy of your spouses’ passport

[ ] A copy of any visa rejections or cancellation notices for your spouse

If you are bringing your children:

[ ] A copy of your children’s passport(s)

[ ] A copy of all English tests taken in the past two years

[ ] A copy of a criminal record check (if required)

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