Apply now for an AIM Overseas program |
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| Applications are now closed for July 2012 programs. Applications for January 2013 programs open on July 9th: please register your interest now. |
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| First Name: * | | |
| Last Name: * | | |
| Gender: * | | |
| Date of Birth: * |
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| University Email Address: * | | |
| Alternate Email Address: * | | |
| Postal Address: * | | |
| Suburb: * | | |
| State: * | | |
| Post Code: * | | |
| Country: * | | |
| Mobile Phone: * | | |
| Home Phone: * | | |
| Work Phone: | | |
| Country of Citizenship: * | | |
| Other Citizenship/Permanent Residency: | | |
| Passport Issuing Country: | | |
| Passport Number: | | |
| Passport Expiry: |
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| Special Dietary Requirements: * | | |
| Diet Notes: | | |
| Allergies: * | | |
| Allergy Notes: | | |
| Chronic Illness: * | | |
| Chronic Illness Notes: | | |
| University: * | | |
| Year Level: * | | |
| Degree/Program: * | | |
| International Student: * | | |
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First Preference July Program: * |
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Second Preference July Program: * |
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| Do you have electives left in your degree? * |
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| Do you intend to seek credit for this program? * |
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| Can we put you in touch with other program participants? * |
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| Where did you hear about this program? * |
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| OS-HELP: * | | |
| Statement: You must write 200-300 words on why you wish to participate in this program e.g. what you think you'll get out of it professionally and personally, what you're looking forward to and why you think you'll be a good addition to the program. * | | |
| Additional Details - Is there anything else we need to know? | | |
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