Application Form

Application

STUDENT DETAILS

(Please check the box where applicable)

Title:
Gender:
Race:
Address
Address
City
State/Province
Zip/Postal
Country

PARENT/GUARDIAN DETAILS

(Details of the account payer)

Title:
Address
Address
City
State/Province
Zip/Postal
Country

PREFERRED EDUCATION INFORMATION

(Please tick the subjects you are applying for)
Subjects:

PROGRAM

Choose a schedule:

PAYMENT DETAILS

(Direct deposit is made into the following account, on or before the indicated date of
payment)
Account Name: MGN COLLEGE PTY LTD
Name of Bank: First National Bank (FNB)
Account Number : 63046319281
Branch Code: 250655

DECLARATION BY STUDENT /PARENT/GUARDIAN

I hereby declare that to the best of my knowledge, the above information provided is accurate and correct.