Registration for Indonesian in-country programs

Please fill in this form to register for a RUILI   Indonesian In-country Language and Cultural Program in either Mataram, Lombok or Kupang, West Timor.

BEFORE filling in this form, please make sure you have read all the information in the RUILI Indonesian In-country Language and Cultural Programs website.

If you encounter any issues with this form, please email indonesian@une.edu.au

PERSONAL DETAILS
e.g. Ms, Mrs, Mr, Dr
Please provide your full address, including number, street, city/town, state, postcode
Please include the area code as well as your number. Do not include any spaces between the numbers.
Date of birth *
Passport date of expiry *
You MUST inform us of any medical conditions you have that may affect your in-country study. Please enter "NONE' if there are no medical conditions.
EMERGENCY CONTACT
e.g. Ms, Mrs, Mr, Dr
This person is your ...
Please include the area code as well as your number. Do not include any spaces between the numbers.
STUDY INFORMATION
University at which you are currently enrolled *
You are undertaking the RUILI study as part of your * Note - students must check with their home universities to make sure there is space within their course structure.
e.g. Bachelor of Languages
MATARAM, LOMBOK PROGRAM
I would like to enrol in the following level in TERM 1 (Wed 3 January to Tues 23 January 2018) of the Mataram, Lombok Program. Please read the language level qualifiers on the RUILI website to assist you with selecting the appropriate language level.
I would like to enrol in the following level in TERM 2 (Thurs 25 January to Wed 14 February 2018) of the Mataram, Lombok Program. Please read the language level qualifiers on the RUILI website to assist you with selecting the appropriate language level.
NEW COLOMBO PLAN
I CONFIRM that I am enrolled at an Australian university and will undertake the RUILI program as part of a Bachelor or Bachelor Honours degree. * Please read the information on the New Colombo Plan (NCP) in the 'Fees-Grants' section of the RUILI website before answering the questions in this section. If you answer 'No' to this question, you are not eligible for an NCP grant. Please go to the next section 'DECLARATIONS'.
I would like to apply for an NCP grant. * If you answer 'Yes' to this question, please answer the next 2 questions. If you answer 'No' to this question, please go to the next section 'DECLARATIONS'.
I CONFIRM that I am an Australian citizen and DO NOT possess at the same time an Indonesian citizenship or residency. If you answer 'No' to this question, you are not eligible for an NCP grant.
I CONFIRM that in the last three years, I have
DECLARATIONS
I DECLARE THAT I HAVE READ, UNDERSTOOD AND WILL ABIDE BY the advice and recommendations for my health and safety on the RUILI website, including as contained in the TRAVEL & SAFETY and CAUTIONS AND WARNINGS sections of the website. I understand that there can be serious consequences if these are not followed, for example, financial loss, illness, injury, imprisonment, loss of life. I understand that I will be provided with a PREDEPARTURE HANDBOOK that will give me further information relating to my health and safety and that I will read and abide by the advice and recommendations in the Handbook. *
MATERIALS RELEASE PERMISSION: I give permission for video footage, audio recordings, photographic images, written material and testimonial statements of me in relation to RUILI activities, to be used free and unrestricted by the Regional Universities Indonesian Language Initiative (RUILI), Charles Darwin University (CDU), University of New England (UNE), University of the Sunshine Coast (USC) and University of Tasmania (UTAS) for marketing, web and media activities including, but not limited to, advertisements, brochures, event promotions, posters, display screens, social media etc. *
I DECLARE that the information submitted above is correct and current to the best of my knowledge. *