Meiji Study Tour 2020

Required fields are marked with an asterisk (*).

Student Number: *

Title:

-- Please Select --MissMrMrsMs

First Name: *

Family Name: *

Phone: *

Email * WSU student email only (Student ID then @student.westernsydney.edu.au)

Alternate email

Date of Birth: *

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Gender: *

-- Please Select --FemaleMaleIndeterminate / Intersex / Unspecified

Citizenship:

AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte d'Ivoire (Ivory Coast)CroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoFormer Yugoslav Republic of MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoFederated States of MicronesiaRepublic of MoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuHoly See (Vatican City State)VenezuelaViet NamBritish Virgin IslandsU.S. Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabwe

Country of Birth:

AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCôte d'Ivoire (Ivory Coast)CroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoFormer Yugoslav Republic of MacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoFederated States of MicronesiaRepublic of MoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussian FederationRwandaSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuHoly See (Vatican City State)VenezuelaViet NamBritish Virgin IslandsU.S. Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabwe

Student Status *

-- Please Select --Domestic studentInternational student

Level of Study: *

-- Please Select --UndergraduatePostgraduate courseworkPostgraduate research

WSU Degree Name: * E.g. Bachelor of Arts

WSU Degree Code *

WSU School: * Where you study your degree

-- Please Select --School of Health SciencesSchool of MedicineSchool of Nursing and MidwiferySchool of PsychologySchool of BusinessSchool of EducationSchool of Humanities and Communication ArtsSchool of LawSchool of Social SciencesSchool of Built EnvironmentSchool of Computer, Data and Mathematical SciencesSchool of EngineeringSchool of Science

Main Campus where you study most:Main Campus where you study most: *

-- Please Select --BankstownCampbelltownHawkesburyLiverpoolParramatta SouthParramatta CityPenrithSydney City Campus

Section 2: Support

If you have any pre-existing health conditions or allergies that may affect your participation in the program, please provide a brief statement. This information will be kept confidential

If you have a disability or might require extra support (facilities, academic support, mental health support) while participating in the program, please provide a brief statement. This information will be kept confidential

If you have any special dietary requirements or cultural needs, please provide a brief statement. This information will be kept confidential

New Colombo Plan

Have you received a New Colombo Plan Travel Grant on a previous occasion? *

• Yes
• No

How old will you be during the travel period overseas? *

Prior to travelling abroad, you will require a valid passport. Do you have a current passport that has more than 6 months until expiration from the date of your return from overseas? *

If 'No' please see the Australian Passport Office or relevant consulate (non-citizens) as soon as possible.

• Yes
• No

Why do you wish to participate in the Study Tour? * (no more than one paragraph)

Section 5: Conditions

I certify that the information in this application is correct. *

• Yes

I understand that on becoming a student in this program, I shall be subject to rules, regulations and requirements as to conduct at Western Sydney University, the host institution and host institution residences. *

• Yes

I understand that in providing my personal information to the University, other than as authorised by law, the University will only use this information for the purposes for which it is being collected in accordance with the University’s functions and activities associated with my enrolment. In some instances, the University may need to disclose information to any Government department which administers or has authority regarding education or immigration policy and law and any other Government agencies (State, Territory or Federal), an affiliated entity of the University, or to third parties for the purposes of recovering unpaid University fees or other debts owed to the University. I consent to such disclosure. *

• Yes

I understand that all information will be collected, stored, accessed and disseminated or destroyed in accordance with privacy, records management and other relevant laws, and the University’s policies. *

• Yes

I understand that the Meiji short course runs from June 27 to July 18. The airline tickets have already been booked to secure a cheap ticket. I am required to travel with the group. No additional travel will be approved as we will be returning to Sydney two days before the Spring semester begins. *

• Yes

I understand that the University reserves the right to vary program fees in the event of changes in exchange rates or price rises made by partners or other suppliers. If the cost of any service increases due to exchange rate fluctuations, price increases, tax changes or any other reason, participants are required to pay the increase when notified or may cancel a program which may result in cancellation fees. *

• Yes