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Family name No
Yes Why do you require a student guardian in Australia?
Given names
DAY MONTH YEAR 8 If you are outside Australia, will you turn 18 years old before arriving?
4 Date of birth No
Yes Go to Question 27
5 Student visa details
Transaction Reference 9 Are you using this form to change your student guardian arrangements?
Number (TRN)
No Go to Part B
Australian visa
grant number Yes
Application ID
10 Give the reason for the change
6 Details from your passport
Passport number
Country of passport
DAY MONTH YEAR
Date of issue
14 Name in guardian’s own language or script (if applicable) DAY MONTH YEAR
OR until
Go to Question 22
15 Has your guardian been known by any other names? 21 Give details of your relative’s Student Guardian visa application
(including name at birth, previous married names, aliases)
No Granted Visa label number
Yes Give details and provide supporting evidence eg. birth V <
certificate/marriage certificate Period of stay Expiry date (DAY/MONTH/YEAR)
Family name MONTHS
19 Does your guardian have a passport? 24 Does your guardian agree to the Department communicating with
him/her by email?
No
No
Yes Give details below
Yes Give details
Details from passport
Guardian’s
Passport number email address
Country of passport
25 You must attach evidence:
DAY MONTH YEAR
Date of expiry • (if your guardian does not hold or has not applied
Issuing authority/ for a Student Guardian visa) that your guardian is
Place of issue as of good character; and
shown in passport • of your guardian’s residence or citizenship status
in Australia (if applicable).
26 To be completed by the student guardian 27 To be completed by the parents or legal custodians if the nominating
I declare that: student is under the age of 18.
• I will provide appropriate welfare arrangements for the nominating I declare that:
student. • the information supplied on or with this form is correct.
• If the student guardian nominated in this form is granted a Student • I have attached all documentary evidence as required.
Guardian visa, the nominating student will reside in Australia with • I am aware that I must immediately advise the Department if I
that guardian, and will not reside with any other Student Guardian become aware that any information provided in this form is incorrect
visa holder, parent or legal custodian. or if there is a change in the nominating student’s circumstances
• I acknowledge my responsibility for organising appropriate that is relevant to this application at any time.
accommodation and travel to and from Australia on behalf of the • I have read the information contained in form 1442i Privacy notice.
nominating student under the age of 18.
• I understand the Department may collect, use and disclose my
• I am aware that condition 8532 will be imposed on the visa of personal information (including biometric information and other
the nominating student under the age of 18 and I will ensure that sensitive information) as outlined in form 1442i Privacy notice.
appropriate welfare arrangements are in place and maintained at all
times. Signature of
student
Signature of
student
(if over the
age of 18)
✍
guardian ✍ Date
DAY MONTH YEAR
Date
Signatures of parents/legal custodians
(if the nominating student is under the age of 18)
We strongly advise that you keep a copy of this form and all Note: Both parents and/or legal custodians must sign this declaration.
attachments for your records.
Signature of
parent/legal
custodian ✍
Family name
Given names
DAY MONTH YEAR
Date
Signature of
parent/legal
custodian ✍
Family name
Given names
DAY MONTH YEAR
Date