General Information

Name of Enquirer (required):

Are you the student the parent  the guardian other (please specify)

Name of Student (if different to Enquirer):

Postal Address:

Contact Telephone Number/s (please include country code)

Home Phone:

Mobile/handphone:

Email (required):

Skype Username (if available):

Who referred you to Dr Simon Yam Training and Consultancy?
 A relative or friend
 Search Engine
 Link from another website
 A registered Singapore Education Agency (please specify)

Student Information

Age of student:

Gender: Male Female

Second Language:
 Mandarin Malay Tamil Others (please specify)

Most recent academic qualifications:
 Cambridge GCE ‘A’ Levels
 Polytechnic Diploma
 National ITE Certificate
 International Baccalaureate (IB) Diploma

Study Major or Course:

Has the student enrolled in a Perth college, university or any other education institution?
 Yes  No (If no, please proceed to the General Enquiry Box below)

If already enrolled, please state which education institution:

When is the student starting his or her study term? (specify date):

When is the student arriving in Perth? (specify date):

In what area or areas will the student need assistance in the most?
 Academic Guidance
 Accommodation
 Social Isolation
 Safety Issues
 Employment
 Transportation (refers to the transport system in Perth, and/or purchasing a vehicle)
 Dealing with Culture Shock
 Settling Down (refers to buying immediate home essentials and familiarising with the immediate surroundings)

Other areas students may need assistance (please specify):

General Enquiry

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