Student Application Form: Personal Details

STUDENT APPLICATION FORM
Initial Registration for Overseas Nurses (IRON)

Registered Nurse (RN) Enrolled Nurse (EN)
Personal Details
1. Surname:
2. Given Name:
3. Middle Name/s:
4. Title: Mr. Mrs. Miss Ms. Dr. Other
5. Marital Status: Single Married Divorced Separated Widow/Widower
6. Is this your legal name? If not, what is your legal name?
Yes No
7. Date of birth (dd/mm/yyyy) 8. Sex : Male Female
9. Home Phone: Yes No 10.Mobile Phone:
11. E-mail:
12. Do you have access to SKYPE? Yes No

13. Address in home country If yes, please provide SKYPE contact details
Street City
Country Postcode:
14. Address in Australia
Street City
Country Postcode:
15. Emergency Contact
Name
Relationship
to you
Phone E-mail
Australian Centre of Further Education Pty Ltd Page 1/3

Phone: (03) 8600 8600 | Fax: (03) 9670 0454 | Email: info@acfe.edu.au | Website: acfe.edu.au
Level 5/341 Queen Street, Melbourne VIC 3000, Australia
ABN: 37 135 002 167 | ACN: 135 002 167 | RTO Code: 40898 | Cricos# 03377J
16. Confirmed Referee Details
Friends Website Advertisement Agent
Others
PRE REQUISITES FOR REGISTRATION WITH AHPRA

Are there any grounds on which the Australian Health Practitioners Regulations Agency (AHPRA) might refuse to register you as a nurse
pursuant to The Health Practitioner Regulation National Law (Victoria) Act 2009 (these grounds include a substance abuse problem or a
physical or mental impairment which significantly impairs your capacity to practice as a registered nurse or any disclosable criminal re-
cord? YES NO
Please refer to www.nursingmidwiferyboard.gov.au for any further information.
If YES, please specify:
APPLICATION PROCESS
The Student Application Form is completed and submitted to Australian Centre of Further Education (ACFE ) with supporting documents
(Minimum Requirement for Enrolment)
If application is successful you will be invited to interview. Interviews are conducted either at our office or via SKYPE.
Application Requirements
Documents Required to Submit this 3. Supporting documents
Application Form Please attach an up to date resume and a letter explaining
the reason why you wish to enrol into the course.
1. Australian Health Practitioner Regulation Agency
(AHPRA) Student must provide an original certified true Additional Documents Required when accepted in
copy of the AHPRA Letter indicating which course they the Program
have permission to complete. This letter must be Valid.
(A valid letter is 12 months from the date of issue) 1. Applicants must provide certified copies of all relevant
information of nursing registration, and other nursing courses.
2. Proof of English language Proficiency
(IELTS) Academic module Test report a minimum overall 2. POLICE CLEARANCE: Students must provide a certified copy
score of 7 and a minimum score of 7 in each of the four of a Police Clearance certificate from country of origin.
components (two sitting is applicable within 6 months National Police Check in Australia
from the first exam)
3. On shore applicants must have a current working with
(OET) with a minimum score of B in each of the four children check (Victoria) or interstate equivalent.
components (two sitting is applicable within 6 months
from the first exam) 4. IMMUNIZATION: Students need to provide evidence of
Immunisation for Hepatitis B, Pertussis, Diphtheria, Tetanus,
Pearson Test of English Academic (PTE Academic) with Measles, Mumps, Rubella, Annual Influenza vaccination,
a minimum overall score of 65 and a minimum score of 65 mantoux, and clear X-ray for Tuberculosis.
in each of the four communicative skills (listening, reading,
writing and speaking)-sitting two (if applicable) 5. OVERSEAS HEALTH INSURANCE: Student must provide
evidence of having Overseas Health Insurance prior to staring
Test of English as a Foreign Language internet-based test course.
(TOEFL iBT) with a minimum total score of 94 and the
minimum scores of 24 for listening, 24 for reading, 27 for 6. Certified Passport Copy and Two (2) passport-size certified
writing, and 23 for speaking. two sitting if applicable. photos taken within the last six (6) months
Course Fee And Refund Policy

1. Application Fee: AUD $250 (non-refundable) this fee is required together with a completed ACFE Application Form
2. Course Fee: AUD $14,000 (inclusive materials)
a. Initial Fee of $7,000 (50% deposit) is required within 7 days of receiving the Letter of Offer and Invoice from ACFE. This fee will
confirm your place in the IRON Program and your Clinical Placement.
b. The balance is required not later than one month prior to the start of the Course or as soon as the Applicant has been granted
Visa by the Australian government.
Australian Centre of Further Education Pty Ltd Page 2/3
Phone: (03) 8600 8600 | Fax: (03) 9670 0454 | Email: info@acfe.edu.au | Website: acfe.edu.au
3. Refunds

All students must refer and read the Fees Charges and Refund Policy located on the ACFE website on the following link:
http://acfe.edu.au/students/fee-refund-policy/
I have read, understood and accept the SM25-Refund Policy pdf

on your website.
Payment or participation in the program does not guarantee recommendation or registration with the Nursing and Midwifery
Board of Australia (NMBA) within the Registered Nurse section of the AHPRA register, this requires successful completion of
the program.
PAYMENT DETAILS
(A) CREDIT CARD All VISA and MASTERCARD transactions will incur a 2.5% additional fee. AMEX will incur a 5.75% additional fee
VISA MASTER CARD CASH BANK CHEQUE
Card Number
VERIFICATION CODE
Card Holder Name (last 3 digits on back of card)
Card Holders Signature EXPIRY DATE
AMOUNT
(B) ELECTRONIC FUNDS TRANSFER (EFT)
Account Name: Australian Centre of Further Education Swift code: NATAAU3303M

BSB: 083 091 Account Number: 162-440-439
Bank Details: National Australia Bank Bank Address: 460 Collins St., Melbourne, VIC 3000 Australia
Please include the Student name in the description box, so we are able to identify payment allocation.
Please allow extra for Bank transfer fees for overseas applications.
Student Declaration
In signing this form I agree:
That the information I have provided on this form is true, correct and complete;
To be bound by the applicable standards of conduct , statutes, regulations , policies and procedures of Australian Centre of Further
Education including any variations that are made from time to time
I read and accept the Fees, Charges and Refund Policy of the Australian Centre of Further Education
I understand that failure to comply with any of the above may result in being unable to register as Registered Nurse in Australia with
AHPRA
Student Signature Date
Please return this Form along with supporting documents to:
The Administrator
Australian Centre of Further Education Pty Ltd.
Level 5, 341 Queen Street. Melbourne 3000 AUSTRALIA
Tel: +613 8600 8600 | Fax: +613 9670 0454 | Email: info@acfe.edu.au
Australian Centre of Further Education Pty Ltd

Phone: (03) 8600 8600 | Fax: (03) 9670 0454 | Email: info@acfe.edu.au | Website: acfe.edu.au Page 3/3

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STUDENT APPLICATION FORM

Initial Registration for Overseas Nurses (IRON)

4. Title: Mr. Mrs. Miss Ms. Dr. Other

5. Marital Status: Single Married Divorced Separated Widow/Widower

6. Is this your legal name? If not, what is your legal name?

7. Date of birth (dd/mm/yyyy) 8. Sex : Male Female

9. Home Phone: Yes No 10.Mobile Phone:

12. Do you have access to SKYPE? Yes No

14. Address in Australia

15. Emergency Contact

Australian Centre of Further Education Pty Ltd Page 1/3

Friends Website Advertisement Agent

PRE REQUISITES FOR REGISTRATION WITH AHPRA

Please refer to www.nursingmidwiferyboard.gov.au for any further information.

If YES, please specify:

Course Fee And Refund Policy

I have read, understood and accept the SM25-Refund Policy pdf

VISA MASTER CARD CASH BANK CHEQUE

Card Holders Signature EXPIRY DATE

(B) ELECTRONIC FUNDS TRANSFER (EFT)

Account Name: Australian Centre of Further Education Swift code: NATAAU3303M

Student Signature Date

Please return this Form along with supporting documents to:

Australian Centre of Further Education Pty Ltd

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