THE INSTITUTION OF ENGINEERS, SRI LANKA
Western Australia Chapter Inc.
66 The Promenade, Mount Pleasant WA 6153; P.O. Box 1266, Booragoon WA 6954,
WA Registration No: A1017751 ABN: 55 342 264 422
Application for the Higher Education Workshop Institution of Engineers Sri Lanka WA Chapter Saturday 06th May 2017 1. Family Name: 2. Preferred Given Name: 3. Email Address: 4. Phone Number: 5. Membership of IESLWA: Member / Not a Member 6. Current Field of Engineering: 7. Highest Academic Qualification (with any Class if relevant): 8. University: 9. Desired Field of Education: 10. Desired Level of Education: Bachelor / Master / PhD 11. Desired Type of Education: By Course work / By Research 12. Desired Mode of Study: Full-Time/ Part-Time 13. Employment Status: 14. Australian Immigration Status: Citizen / Permanent Resident / Temporary Resident 15. Fee Payment: Self-Financed / Government Supported / Need a Scholarship 16. Any Other Relevant Information such as English Competency:
Web: www.ieslwa.org | Email:
[email protected]
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THE INSTITUTION OF ENGINEERS, SRI LANKA
Western Australia Chapter Inc.
WA Registration No: A1017751
66 The Promenade, Mount Pleasant WA 6153; P.O. Box 1266, Booragoon WA 6954,
ABN: 55 342 264 422
17. If you are not a member of IESLWA, are you happy to become a member? Yes/No/ Not Applicable If a different email address to be used for emails from IESLWA please provide it here.
Signature
Date
(Please send the completed form with the scanned copies of supporting documents to
[email protected] with the subject ‘IESLWA Higher Education Workshop’ before the due date.)
Web: www.ieslwa.org | Email:
[email protected]
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