Pacific POLYTECH

Fiji

International Student Application Form

1. PERSONAL DETAILS

First Name

Middle Name

Last Name

Date of Birth dd / mm / yyyy

Gender :(Required)

Male

Female

Marital Status :(Required)

Single

Married

Nationality :

Passport No

Expiry Date dd / mm / yyyy

Country of Issue :

Postal/Home Address :

Email :

Phone/Mobile No :

2. EDUCATION AGENT DETAILS (IF APPLICABLE)

Agency Name:

Contact Person :

Agent Email :

Agent Phone :

3. ENGLISH LANGUAGE COMPETENCY

International students must demonstrate proficiency in English language. Please complete the option that applies to you:

Option A: English was the primary medium of instruction in my secondary / tertiary schooling.

Option B: I have taken an official English Proficiency Test (Attach certified copy of results):

English Proficiency Test Result Attach:

Test Name

Score Achieved:

Date Taken dd / mm / yyyy

Option C I have only the following level of English Competency and will need to enrol in an English Competency programmes at Polytech prior to commencing my preferred programme. [Details on the relevant English competency programme recommended for you will be sent to you upon assessment of your application]

	Level
	Certificate of Competency : Elementary English: Elementary level; designed for those with no prior English exposure, to gain basic introduction to English Language
	Certificate of Competency : Basic Spoken/Written English
	Cert I: Basic English: (Basic Reading/Writing Competency)
	Cert II: Intermediate English: (Enough to communicate with English speakers)
	Cert III: English Competency: (Read/Write/speak with moderate confidence)
	Cert IV: Intermediate English Competency: (Read/Write/speak with confidence – IELTS above Level 5 competency)

4. PROGRAMME OF STUDY

Select 1st Choice Programme:(Required)

Select 2nd Choice

Select 3rd Choice :

5. ACADEMIC HISTORY (HIGHEST EDUCATION LEVEL)

School / Institution

Country

Year Completed

Qualification Obtained:

Marks / Grades:

6. FUNDING SOURCE & MEDICAL DECLARATION

Funding Source:

Private / Self-Funded

Home Government Scholarship

Other Source

Please indicate whether you have any medical condition(s)
or major illness(es) that will impact on your studies

7. ACCOMMODATION ASSISTANCE

I WILL need advice on accommodation options.

I WILL NOT need advice on accommodation options.

8. APPLICANT DECLARATION

I declare to the best of my knowledge that all the information supplied with this application form is true and complete in all significant particulars. I undertake to comply with the rules and regulations of Pacific Polytech, and I fully understand that making a false declaration is an offence under the law.

An unhandled error has occurred. Reload 🗙