Icarus College as agent for Vanuatu College of Medicine:

APPLICATION FORM FOR ADMISSION TO PROGRAMS

Before completing this form, please study the VCM Student Handbook carefully


1. PERSONAL DETAILS


Title: *
Use your name as it appears on a government - issued identity document, such as a passport.
Last Name: *
Given Names: *
Preferred Name:
Date of birth (dd/mm/yyyy): *
Gender: MaleFemale *
Country of Birth: *
Citizenship: *
Passport No (for student visas):
Do you suffer from any condition - medical or otherwise, which will require the University to make special provision for you, either academically or with regard to on-campus accommodation?
YesNo *
If Yes, please provide details below:

Address for Correspondence
Address: *
Address:
City: *
State: *
Post Code: *
Country: *

Permanent Home Address
Address:
Address:
City:
State:
Post Code:
Country:

Contact Information
Email: *
Ph Business:
Ph Home: *
Ph Mobile:
Ph Fax:

Visa Details
Do you have a current Australian visa?
Yes No *
Visa Expiry Date (dd/mm/yyyy):
3 digit code: Visa type:


2. PREFERRED COURSE(S) OF STUDY
Preferred admission date (dd/mm/yyyy): *
Indicate the course for which you wish to be considered.
*
Do you intend to study full-time or part-time?
Full-time Part-time *


3. CREDIT/EXEMPTION
Are you seeking credit/exemption for previous tertiary study?
Yes No *

4. SCHOLARSHIP REQUEST
Do you wish to be considered for a Vanuatu College of Medicine Scholarship?
Yes No *

5. HIGH SCHOOL/ MATRICULATION STUDIES
Give details on your high school studies (e.g Senior, HSC, "A" Levels, Senior High School)
Year(s) Name of Qualification School or College State or Country Result (TER etc)
1991-1992 Senior Certificate Marymount College Queensland

6. TERTIARY EDUCATION
List in chronological order all university or other post-secondary courses attempted or completed.
Year(s) Name of qualification School, College, University State or Country F/T or P/T Completed If incomplete, Enter last year enrolled
1993-1995 Bachelor of Arts University of Queensland Queensland F/T Complete

7. EMPLOYMENT HISTORY
Please include the most recent employment only
Employer Position/nature of duties F/T or P/T Start Date End Date

8. PROFESSIONAL MEMBERSHIPS & REGISTRATIONS
Type (eg Nursing, Teaching etc); State or Country; Registration Number; Is Registration Current;

9. LANGUAGE DETAILS
Is English your first language?
Yes No *
****If you answered Yes to the previous question, please go on to section 10, otherwise continue****
Were your secondary / undergraduate studies conducted in English?
Yes No *
Have you taken an English proficiency test or GRE in the last 2 years or do you intend to take one ?
Yes No *
If yes, name of test: Date(dd/mm/yyyy): Score:
If you do not meet the University's English entry requirements, do you wish to study English at our government accredited English Language Institute?
Yes No *

10. DECLARATION
Are you at present excluded on academic or other grounds from any tertiary institution?
Yes No *
If yes, please provide details below.

11. AFFILIATION
How did you hear about Vanuatu College of Medicine? *
Friend/Family Member
Advertisement (Paper)
Advertising(Radio/TV)
Internet
Careers Market
Careers Adviser (School)
Other.....

12. GENERAL QUESTIONS
Please answer all questions honestly and as concisely as possible. Please Limit answers to approximately 150 words.
What personal characteristics do you think you have to become a doctor? *
How do you know you have these characteristics? *
What voluntary work have you undertaken while at school and/or at university?
Where were you born? *
Where did you attend secondary school(s)? *
What are your main reasons for choosing to study Medicine at Vanuatu College of Medicine? *
Apart from medicine what other careers have you researched?
Do you believe you have the self discipline and independence to complete a largely distance degree? *
Have you studied independently before?
YesNo *
If yes, please explain:
Tell us about your interests. *
Besides English, do you speak any other languages fluently?
Whom may we contact as a general referee, if this is necessary? Please include name and contact details. (This person does not have to be an academic, or from your school.) *
Do you have a criminal conviction or any other impediment which you believe may prevent your practising medicine?
YesNo *
If yes, please give basic details:
Do you wish to add anything you feel may be relevant in supporting your application to Vanuatu College of Medicine?

13. PRIVACY COLLECTION STATEMENT
Vanuatu College of Medicine ('VCM') may collect personal information about you, including:
  • the information on this form; and
  • information on other forms or documents requested by, and provided by you or other educational institutions to, VCM.
VCM collects this information for the purpose of:
  • assessing your application;
  • providing services to you;
In the case of visa details, VCM is required to collect this information pursuant to Local Immigration Laws.

VCM may disclose personal information about you to:
  • service providers, who assist VCM in operating its business, however, these service providers are required to comply with VCM's privacy policy in how they handle your personal information;
  • in the case of an emergency involving you, your next of kin; and
  • your agent, whose details appear on the front of this form, and/or your next of kin for the purpose of processing your application.

If the personal information you provide to VCM is incomplete and/or inaccurate, VCM may be unable to process this application and/or be unable to provide you with the services you are seeking.

You may access the personal information VCM holds about you in accordance with VCM's privacy policy.


PRIVACY POLICY for ICARUS College acting as agent for Vanuatu College of Medicine.

ICARUS College respects your privacy. We have created this privacy statement in order to demonstrate our commitment to you, our customer. This privacy statement discloses the privacy practices for this site, www.medical-entrance.com.au.
We do not rent our mailing list to 3rd parties.
We will never give any contact information about you to others without your express permission. Our site uses forms in which you give us contact information (like your name, address, and email address) so you can place orders, request information and support, and make product suggestions. We use your customer information only when it will be important for us to contact you regarding functionality changes to our products, our web site, new ICARUS College services, and special offers we think you'll find valuable. We use information gathered about you from our site statistics (for example your IP address) to help diagnose problems with our server, and to administer our Web site. We also gather broad demographic information from this data to help us improve our site and make your browsing and purchasing experience more enjoyable. This is not linked to any personally identifiable information.
Our site uses cookies to keep track of your shopping cart and receipts. We use cookies to identify you so you don't have to login each time you visit our site.
This site also contains links to other sites. Unfortunately www.medical-entrance.com.au is not responsible for the privacy practices or the content of such Web sites.

Security - This site has security measures in place to protect the loss, misuse and alteration of the information under our control.

Updating your information - As a customer of ICARUS College, you may alter your customer information or opt-out of receiving communications from us and our partners at any time. To change or modify your customer information, simply login to your personal administration panel, using your discrete username and password.You may also email us at techsupport@medical-entrance.com.au

Sending Emails - We use emails to communicate with you, to confirm your placed orders, and to send information that you have requested. We also provide email links, throughout the medical-entrance website, to allow you to contact us directly. We strive to promptly reply to your messages. The information you send to us may be stored and used to improve this site and our products, or it may be reviewed and discarded. However, your information will only be shared with third parties with your explicit permission.

Exceptional Circumstances - As stated previously in this policy, we will never give out your information without your permission. The only exceptions to this are, when we are required by law, in the good-faith belief that such action is necessary in order to conform to the requirements of the law, or we must comply with a legal process served on our web site.

Changes In Our Practices - If we change our information handling practices or other privacy aspects, we will post those changes on this privacy statement, at least 30 days prior to their implementation. We will also notify you directly via email.

Service Provider - We use a credit card processing company to charge users for goods and services. These companies do not retain share, store or use personally identifiable information for any secondary purposes.

Contest - From time-to-time our site requests information from users via surveys or contests. Participation in these surveys or contests is completely voluntary and the user therefore has a choice whether or not to disclose this information. Information requested may include contact information (such as name and postal address), and demographic information (such as post code, age level). Contact information will be used to notify the winners and award prizes. Survey information will be used for purposes of monitoring or improving the use and satisfaction of this site.

Tell-A-Friend - If a user elects to use our referral service for informing a friend about our site, we ask them for the friend's name and email address. ICARUS College will automatically send the friend a one-time email inviting them to visit the site. ICARUS College stores this information for the sole purpose of sending this one-time email. The friend may contact ICARUS College at techsupport@medical-entrance.com.au to request the removal of this information from our database.

Use of materials for advertising purposes - It is a condition that all students of ICARUS College and registered users of this website grant unreservedly to ICARUS College the use, of any materials, test results,media clippings, photographs or emails received from them, for the purpose of advertising as is deemed fit by ICARUS College. Such use may not be for criminal or immoral purposes. ICARUS College remains indemnified against all legal actions from all students of ICARUS College and site users in regards to this Privacy Policy and all clauses contained within.


14. FURTHER INFORMATION
It is not necessary to send documentation with this form. Should you be offered a place you will be advised and asked to supply certified copies of documentary evidence. You will also be asked for proof of identity. A copy of the identity page from a passport is preferred. We will also ask for a digital "head-and-shoulders" picture 100 pixels square to be sent by e-mail.

15. SUBMISSION
Thank you. Please click on the button below to submit your application and to receive your confirmation page.
Please note by submitting this application you agree to be bound by the Privacy Policy above and any addtional terms and conditions listed on this website.



* RTO 21457