Shafston International College – Public Testing CentreNew TOEIC Test Application Form – 2017 (redesigned TOEIC test)

You must pay the fee (includes GST) at the time you lodge your test application.

Test - Score Report with Photo $180.00

SHAFSTON HOUSE COLLEGE LIMITED | RTO Code: 32004 | CRICOS Provider Code: 01542F

Student Number:

Date of Birth:

Nationality:

Family Name:

Other Name/s:

Current Local Brisbane Address:

Brisbane Phone:

Email Address:

Current Class:

Title (select one): Miss / Ms / Mrs / Mr

Test Applicants: Please complete all of the following sections

• One current PASSPORT PHOTO• Please bring your PASSPORT with you on the day of the test.• Please meet at ELICOS Reception at 1.00pm on the test day.• The test begins at 1.30pm. No late arrivals will be allowed to enter testing room.• Results are available for collection from ELICOS Reception one week after the test.

Day Test Date Application must be in by: Friday 1.30pm Friday 27 January Wednesday 18 January Friday 1.30pm Friday 24 February Wednesday 15 February Friday 1.30pm Friday 24 March Wednesday 15 March Friday 1.30pm Friday 21 April Wednesday 12 April Friday 1.30pm Friday 19 May Wednesday 10 May Friday 1.30pm Friday 16 June Wednesday 7 June Friday 1.30pm Friday 14 July Wednesday 5 July Friday 1.30pm Friday 11 August Wednesday 2 August Friday 1.30pm Friday 8 September Wednesday 30 August Friday 1.30pm Friday 6 October Wednesday 27 September Friday 1.30pm Friday 3 November Wednesday 25 October Friday 1.30pm Friday 1 December Wednesday 22 November

Number of times you have taken the test:

I agree that the above information is true and correct and I will uphold the integrity of the TOEIC test. My enrolment is accepted when I have paid the test fee. Cancellations on the day of the test will receive no refund. Cancellations before the day of the test incur a $40 administration fee.

Signature: ___________________________________________ Date: ___________________________

Date Paid:

Receipt Number:

Amount Paid:

Cashier Signed:

IF POSTING, PLEASE SEND TO: DOS, TOEIC TEST, SHAFSTON INTERNATIONAL COLLEGE, 46 THORN STREET, KANGAROO POINT, QLD, 4169. PLEASE INCLUDE POSTAL ORDER AS PAYMENT, OR REGISTER AND PAY IN PERSON AT SHAFSTON COLLEGE WITH THE COMPLETED APPLICATION FORM AND PAYMENT, 2 WEEKS BEFORE THE TEST DATE.

2017 TOEIC TEST A

PPLICATION

FORM