Application Form Monash College

Fill out the form carefully for registration

Personal Details

Student Name (as in passport)



Nationality (as in passport)

Country of Birth

Mobile Phone

Email Address

Postal Address

City / Regency

State / Province


Postal Code

Father's Name

Mother's Name

Father's Email

Mother's Email

Father's Phone Number

Mother's Phone Number

Intake and Programs

Please indicate which intake and program you are applying for:

Monash College Program

Intake Month Monash College

Year of entry Monash College Year

Intake Month Monash Foundation Year

Year of entry Monash University Foundation Year

Degree Preferences

Application Details

Are you citizen of Australia or New Zealand or a Permanent Resident of Australia?

Have you previously applied to another Monash campuses

The application form is submitted by

Specify The Name


School / Institution Name



Year / Level

English Language Proficiency

English was the language of instruction in previous studies completed

I have sat for IELTS / TOEFL iBT. The result is

Declarations & Signature

I declare that the information provided by me in this application, or provided in support of my application, is voluntary, correct, complete and true. The information collected on this form is used primarily to assess your application for entry, and if successful your enrolment into Monash College Program at Jakarta International College.

I acknowledge that an imcomplete application may not be processed. I understand that only certified copies of documents will be accepted and submitted documents will not be returned.

The information I have provided is protected and governed by relevant privacy legislation. JIC, Monash College Pty LTd and Monash University will not disclose personal information to third parties without written consent or when required by law, except in emergency situations.

I am aware of the tuition fees and living expenses associated with studying at JIC and hereby I declare that I have sufficient resources to cover my expenses for the full period of my study. I authorise JIC and Monash College Pty Ltd to obtain information from any education institution that I have previously attended or enrolled in to verify my grades and / or qualifications.

I understand that JIC and Monash College Pty Ltd reserve the right to amend or reverse any decision related to an offer of admission or enrolment on the basis incorrect or incomplete information.

I have read and understood the terms and regulations pertaining to my application to study a Monash College program at the Jakarta International College and accept them in full.

I am fully aware that JIC reserve the right to make changes to the terms and regulation without prior notice.

The information collected on this from is used primarily to assess my application for entry, and if successful, my enrolment into a Monash College Program at Jakarta International College.

I understand that Monash College and Monash University may access this information to communicate directly with me.

For further information, please see the Student Privacy Collection Statement at :

Signature (Student)

Signature (Parent / Guardian)