Student Details
First Name(s): Please enter the first name(s) / given name(s) on your passport
Other Names:  
Last Name: Please enter the last name (family name) on your passport
Previous Last Name:  
Nickname (English Name): Please enter your nickname or English name
Date of Birth: //    (age: 0 years 0 months)
Birth Country: 
Citizenship Country: 
This information is only being collected for statistical purposes.
Applicant Phone: 
Applicant Mobile Phone: 
Applicant Work Phone: 
Applicant Fax: 
Email: Please enter student's email address
(not that of a La Trobe University representative)
Your new username and password will be sent to this address

Previous LTU Student Number: 
Correspondence Address
Address 1:  
Address 2: 
Address 3: 
State: Postcode: 
Visa Details
Passport Number: 
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