Education Abroad Registration

Overseas Program Student Agreement and Acceptance Offer

This form must be completed if you are going overseas on an RMIT approved activity (for credit or not for credit). This can
include but is not limited to:
- Exchange
- RIIERP
- Study Tour
- Short-Term Program
- Internships
- Field Work, Clinical placements
This form is for ALL RMIT students including VET, Higher Education and Higher Degrees by Research students.
Where the program is NOT a full-semester or year long exchange program this form is also an application for the Student
Mobility Grant. Exchange students apply for mobility via the exchange application.
This form is required to access the OS-Help loans.
Through this form you can also register your travel insurance details with the Education Abroad Office. This is a
requirement of your overseas program. If you don't have your insurance details now you can complete this later separately
via the travel insurance site.
Please read all instructions carefully.

Have you already completed this form and just need to register your TRAVEL INSURANCE DETAILS?
No, I have never completed this form
Yes, I have completed this form and just need to enter travel insurance details

Select your program type

What program are you accepting your place in?

Exchange
RIIERP
Study Tour
Short Term Program
Internship (other than RIIERP)
Other (field work, clinical placement etc.)

Congratulations!
Youre about to head overseas and add to your Global Passport. Youll learn with and from people from many different
backgrounds and cultures, experience the excitement and challenge of seeing the world through different eyes; and spend
part of your education immersed in a place that you dont call home.
To formally accept you place in the RMIT University Outbound Mobility Program, please carefully read the following terms
and conditions.

Pre-Trip Questionnaire
Some light stuff before we get into the hard questions.

Where did you hear about RMIT Education Abroad programs?

Check all that apply
Education Abroad Information Session

Friend

Education Abroad Facebook Page

RMIT academic

Education Abroad Website

RMIT CareerHub
RMIT University Facebook page

Website (external to RMIT) - please enter website

Other - please describe

Have you attended any of the following events?

Canada Day - May 15, 2014
Asia Week - July 28 - August 1, 2014
Mexico Day - September 2014
Bastille Day - July 2014
Oktoberfest - Sept-Oct 2014

What MOST influenced your decision to participate in an overseas program?

Friends recommendation
RMIT academic advice
Family suggestion
EAO information session
Program location
Program reputation
Program match with my RMIT program
Other:

What influenced your decision to chose your destination LOCATION?

Not important

Some impact

Very important

Some impact

Very important

Language of program
(English)
Language of program
(Language other than
English)
Country's national language
(English)
Country's national language
(Language other than
English)
Friends recommendation
RMIT academic advice
Family suggestion
Program reputation
Program match with my
RMIT program
Program length
Host country Health and
Safety
Distance from Australia
EAO information session
Other:

What influenced your decision to chose your mobility PROGRAM?

Not important
Program location
Program reputation
Program match with my
RMIT program
Program length
Friends recommendation
RMIT academic advice
Family suggestion
EAO information session
Other:

What do you hope to gain from the experience?

Increased Self-Confidence

Increased Independence

Networking/Collaboration Opportunities

Increase career prospects

Increased Language Proficiency

Other:

Increased Cultural Sensitivity

Why did you choose to participate in an overseas program?

I.e. Academic / experience / to meet new people / new culture etc. Please explain.
Academic

What are you most excited about?

Learning

Global Mobility Promotion

We want to get the word out about international education. The best ambassadors are the people that know! Wed love it if
you could assist in the promotion and activities of the Education Abroad Office and/or your School. Activities could include
talking at student events, writing articles and blog posts, promotion through social media etc. Interested?

Yes
No

Student Mentor Program

Its a tough world out there and it makes it much easier for students going on a mobility program to talk to other students
who have gone on a mobility program. Would you be happy for use to pass on your contact information to other students
who have questions about their program?

Yes
No

Using your photos or words

Did you know that if you submit photos to us or provide testimonials about what a great time you had we can use this for the
purposes of promotion? Are you ok with that?

Yes
No

Personal Details

First name (as it appears on passport)

Kei Jin

Surname (as it appears on passport)

Pook

Student Email
s3464569@student.rmit.edu.au

Date of Birth
format: dd/mm/yyyy
01/02/1991

Gender
Male
Female

School
Architecture and Design

Program
Program Code
(for example: BP222)
MC163

Program Name
(for example: Bachelor of Communication (Professional Communication)
Masters of Architecture

Program Level
PGRD

Are you an Australian Citizen or Permanent Resident?

Yes
No

Are studying at RMIT on an International Student Visa?

Yes
No

Country of Citizenship
Malaysia

Notification for International Students

I understand that as an international student if I will be absent from Australia for more than 28 days, I must obtain a letter
from the RMIT University Education Abroad Office to confirm my participation in the overseas program. It is then my
responsibility to notify the Department of Immigration and Citizenship (DIAC) at least 28 days prior to my departure.

Yes

Overseas Program Information

Name of the Study Tour

Refer to the education abroad website and list the name of the study tour.
Designing Resilience in Asia 2015 International Design Competition, Symposium

RMIT Study Tour Coordinator or RMIT Program Coordinator/Manager

This must be an RMIT staff member
Lindsay Holland

RMIT Study Tour Coordinator or RMIT Program Coordinator/Manager Email address

This must be an RMIT email address
lindsay.holland@rmit.edu.au

Destination City
Singapore

Destination Country
Where there is more than one select the country where you will spend the most time
Singapore

Program Start Date

format: dd/mm/yyyy
29/06/2015

Program End Date

format: dd/mm/yyyy
30/06/2015

Enrollment Declaration

I understand that it is my responsibility to ensure that I am correctly enrolled at RMIT, and overseas if applicable, for the
duration of my Program.
I also understand that it is my responsibility to ensure this enrolment is correct by the census date of each semester of the
program I participate in.
I agree to consult my Academic Program Director before departure to ensure that I am correctly enrolled for the duration of
my program.

Yes

I understand that I am required to undertake all study, training, fieldwork and tasks of the Program as outlined by my School
and that failure to do so may affect my credit transfer.
Yes

Program Conditions

Unforeseen events
I understand that RMIT University reserves the right to change or, if necessary, under exceptional circumstances terminate
a students Outbound Mobility Program, if in its view continuance of the particular program would place in jeopardy either the
Universitys reputation, the safety and wellbeing of the student, or continued good relations with the partner institutions.
Yes

Student Mobility Grant

Are you applying for an RMIT Student Mobility Grant?
Please read terms and conditions here. Note that applications CLOSE one the first day of the month prior to the study tour.
For example: if your study tour starts in March you need to apply by Feb 1.
Yes
No

Student Mobility Grant

Applicant declaration
I understand that my personal and bank details may be made to the RMIT Payroll area to facilitate payment of
the RMIT Student Mobility Grant.
I certify that I understand the conditions by which my application will be assessed and understood the
conditions by which RMIT Student Mobility Grants are awarded.
I have included my 'academic history - course list' electronic copy (available from myrmit) with this
application.
I acknowledge I have not received any other funding from RMITs Education Abroad Office (this does not
include OS HELP).
I acknowledge that if I am completing an internship I am only eligible for the Student Mobility Grant if the
internship is UNPAID

Upload academic history course list

Academic history.docx
10.4KB
application/vnd.openxmlformats-officedocument.wordprocessingml.document

University Funds and Scholarships

Are you applying for OS-Help?

This is NOT an application for OS-Help. It just states your intention - please refer to the RMIT OS-Help site for details on
how to apply.
Yes
No

I understand that RMIT is not obliged to provide any funds to assist with the payment of any of the expenses referred to in
this document unless it has agreed to do so in a signed letter addressed to me.
Yes

I understand that should I choose to withdraw from the program, I will have to return any RMIT grant or scholarship funding
awarded to me, except in exceptional circumstances. The Assistant Director, International Relations will assess what
circumstances may be deemed exceptional.
Repayment of the grants or scholarships administered by the RMIT University Education Abroad Office is required if:
The proposed travel for this program is cancelled, not completed, or if the student fails to meet the terms and
conditions of the specific program.
For Semester Exchange, Semester Study Abroad, Short Term Programs/Study Tours, Clinical Placements, and
Internships, failure to achieve a satisfactory result, as determined by the RMIT University Education Abroad Office
and RMIT University School.

Yes

Student Responsibility

Disclosure of personal information

I consent to the disclosure by RMIT of any personal information about me, including my academic record, in any or all of the
following circumstances:
If it facilitates the provision of my overseas program my details may be provided to the host institution or relevant
hosting organisation;
If RMIT believes the disclosure would assist any hospital or other medical provider;
If RMIT believes the disclosure would assist in satisfying my immigration or visa requirements during the Program or
otherwise facilitate my travel;
If RMIT believes the disclosure is required to enable or assist me to obtain other funds; and
I acknowledge that RMIT may be required to disclose my personal enrollment and academic details in certain
circumstances.
Yes

Program Withdrawal
I understand that should I choose to withdraw from the program, I will have to inform the RMIT University Education Abroad
Office in writing of my intention to withdraw from the program as soon as possible.
I understand that there may be fees associated with withdrawal after a certain date.
Yes

Maintaining contact
I understand that I will need to check my RMIT email account regularly before and during my program as this is the primary
form of communication between RMIT University and myself.
Yes

Expenses:
I agree to pay all expenses associated with my overseas program including but not limited to: All travel, visa, study,
accommodation, living expenses, tuition/course fees and any cost resulting from the modification or termination of my tour.
Commonwealth Supported Places (CSP) or Full Fees (local students) or Tuition fees (International students);
The cost of text books and educational supplies required for the Program;
All travel, visa, accommodation and living expenses associated with my participation in the Program;
All health insurance costs and medical and pharmaceutical expenses incurred for my benefit; and
All costs resulting from the modification or termination of my participation in the Program

Yes

Emergency Contact Information

I am aware that I am responsible for updating my emergency contact information in myrmit.edu.au. This contact will be
utilised in an emergency situation.

Yes

Indemnity
I agree that I will indemnify the University from and against any liability, loss, harm, damage, cost or expense (including
legal fees) that the University may suffer, incur or sustain as a result of my conduct during my participation, except to the
extent that such liability, loss, harm, damage, cost or expense arises from the negligent or unlawful act or omission of the
University.
I agree

Additional Terms (specific to an individual overseas program)

I understand any information provided to me regarding accommodation, or other service providers related to this overseas
Program, is not a recommendation or referral and I am not obligated to accept them.
I confirm that I am proceeding with the arrangements to undertake my Study Tour/Placement/Fieldwork/Internship of my own
free will, and subject to the above conditions.
Yes

Before I leave Australia

Pre-departure briefing
I acknowledge that I have been requested to attend and participate in a Pre-departure briefing conducted by my School, the
RMIT University Education Abroad Office or available online, and that I have received a copy of the Education Abroad
Office Pre-departure Handbook and have noted the terms of the advice that it contains.
If you have already attended the Pre-departure briefing click "I Agree" below
If you have not already attended the Pre-departure briefing you agree by clicking "I Agree" that you will contact the RMIT
University Education Abroad Office in order to be updated with the information you missed.

I agree

Passport
I agree to obtain a passport prior to my departure, or ensure my current passport is valid for the duration of the program plus
six months.
I agree

Visas
I understand that I am responsible for obtaining the appropriate visa or entry documents prior to my departure. The RMIT
University Education Abroad Office will not dispense visa advice and I must contact the relevant consulate or embassy
directly.
I agree

Health & Travel Insurance and Medical Pre-departure check

I agree that I am responsible for obtaining insurance that will provide me with medical and health coverage for the duration of
my participation in the Program, and that I am responsible for my own travel insurance. This is exclusive of any travel and
health requirements set by the Host Institution.
I also accept responsibility for receiving all the necessary vaccinations recommended or required for entry into my host
country. Additionally I acknowledge the recommendation that I seek the advice and a medical check-up from my doctor prior
to my departure overseas.
I agree to register my travel insurance details with the RMIT University Education Abroad Office and complete a My Trips
Profile more than 10 days prior to travel. I agree to keep the My Trips profile up-to-date if and when my travel itinerary
changes
I agree to purchase travel insurance, register my insurance details 10 days prior to departure, and complete a
My Trips Profile.
I already have travel insurance and need to register with EAO and complete a My Trips Profile.

International SOS
I understand that RMIT partners with International SOS, a leading medical assistance, and international healthcare and
security assistance company. I can access an iSOS membership card and other relevant travel information via the Travel
Advice section of the Education Abroad (Outbound students) webpage.
I agree

Returning to Australia

I understand that I must submit a Student Feedback Form to the RMIT University Education Abroad Office within 3 months
of the completion of my program.
Yes

Conduct Guidelines

I acknowledge and understand that:

I will be acting as an ambassador of RMIT throughout the program. I will conduct myself in accordance to
laws and cultural norms of the country I will be visiting. This means I will behave in a manner that will not
compromise my or RMIT's reputation.
I agree that RMIT University may terminate my participation in the program if I fail to maintain what RMIT
University considers to be an acceptable standard of public and private conduct, as per RMIT University
Statute 6.1 Student Discipline.
I will Inform the group/buddy/mate/colleague of my individual movements and whereabouts, therefore placing
me and my group's safety first.
I will not buy or accept illicit drugs from anyone.
I will respect cultural, university and community guidelines, and spiritual differences in the host country
I will respect the confidentiality, privacy and personal requirements of individuals in the host country and study
tour group members.
If in doubt, I will contact my host university, the Education Abroad Office, RMIT staff in my School or an
iSOS representative for assistance.

Acceptance of the Offer

The undertakings contained in this program Agreement and Acceptance of Offer Form shall become effective from the date
of submission and shall remain in effect for the duration of the program (including any authorised program extension).

I,
Kei Jin Pook wish to participate in the international program to Singapore from 29/06/2015 to 30/06/2015.

Declaration
I hereby declare that the information provided on this application is correct and complete.
I authorise RMIT University to obtain official student records from the relevant institute/organisation to make
an informed decision about my application or matters relating to enrolment.
In an emergency I hereby grant RMIT University staff the authority to contact the nominated emergency
contact on my behalf.

Form feedback
RMIT Education Abroad are constantly striving to improve your experience in preparing for, going on and returning from your
overseas program.
We value your feedback!
If you have any feedback or comments regarding this form please feel free to leave them here.

Program Coordinator/Manager Approval

*Please read - important instructions
After you click 'next' you will be taken to a response summary page.
Please follow these steps:
Download application as a PDF
Send via email to the email address listed below
Include the following text instructions
*******************************************
Dear [insert name]
I have just accepted a place in the [insert name of program] and have completed the overseas program agreement form.
This requires your approval before it can be finalised and I can be considered for a student mobility grant and OS-Help (if
applicable).
Can you please:
Review the attached form
Forward my email with the form to eao@rmit.edu.au with the following text:
*******************************************
I approve [insert student name] as a participant of the program detailed in the attached form. I confirm that RMIT
recognises this activity is full time and directly related to the students RMIT academic program (for credit or not for credit).
Regards
******************************************
Don't forget to submit the form to complete the process (if you don't receive a message - THANK YOU FOR
COMPLETING THIS FORM - your form HAS NOT been submitted correctly
lindsay.holland@rmit.edu.au