1. No category

Change of care arrangements form
Current students
Return completed form to:
Reception
Student Administration
Students do not complete this page. Start completing the form on page 2.
Please ensure that you have attached all the necessary documents. It may take up to 14 days
from date of receipt of this completed document to approve your request.
Section to be retained by Monash College
Form received by: __________________
MCPL stamp
Date:____________________________
Checklist:
Section 2: parent has signed
Section 3: If living with Family Friend, copy of Statutory Declaration and Photo ID attached
Section 4: Parent and caregiver have signed
Section 4: Copy of confirmation of accommodation arrangement attached
Section 4: If living with Family Friend, copy of Statutory Declaration and Photo ID attached
Section to be retained by student
Form received by: __________________
MCPL stamp
Date:____________________________
Checklist:
Section 2: parent has signed
Section 3: If living with Family Friend, copy of Statutory Declaration and Photo ID attached
Section 4: Parent and caregiver have signed
Section 4: Copy of confirmation of accommodation arrangement attached
Section 4: If living with Family Friend, copy of Statutory Declaration and Photo ID attached
IMPORTANT: This section indicates receipt of ‘Under 18 change of care arrangements form’. It does not
validate its content, accuracy and/or approval. Your application will be assessed and you will be informed of
the outcome by email. Official approval from Monash College will be documented on page 3.
monashcollege.edu.au
CRICOS provider: Monash College 01857J
ACN: 064 031 714
monashcollege.edu.au
CRICOS provider: Monash College 01857J
ACN: 064 031 714
For information please refer to:
http://www.monashcollege.edu.au/live-and-study-in-australia/under-18s.html
Section 1. Student personal details
Monash ID number:____________________________
Current course:____________________________
Family name:_________________________________
Given name:______________________________
Telephone:
Mobile: __________________________________
______________________________
Date of birth:_________________________________
Email address:_____________________________
Passport number:_____________________________
Nationality (as per passport):__________________
Current caregiver guardian’s name:_________________________________________
Current caregiver company (if applicable:____________________________________
Section 2. To be completed by parent
Parent or legal custodian details
Full Name:______________________________
Address:________________________________
Telephone:__________________________
Mobile:_________________________________
Email address: ______________________
Relationship to student: ____________________
Passport number:_____________________
Nationality:______________________________
I approve the change of care arrangements / accommodation below.
✓ Please tick as required
Change of caregiver/guardianshipservice
Complete section 3
Change of accommodation
Complete section 4
Parent signature:____________________
Date:________________________
OFFICIAL APPROVAL MONASH COLLEGE USE ONLY – DO NOT COMPLETE THIS SECTION
Approved
Authority name:
Date:
Authority title:
HAS home inspection date (if applicable):
Authority signature:
monashcollege.edu.au
CRICOS provider: Monash College 01857J
ACN: 064 031 714
Section 3. Change of caregiver/guardian
✓ Please tick and complete only one option
Relative
aged over 21:
This arrangement must be approved by the Department of Immigration and Border Protection (DIBP). You will
need to submit Form 157N to DIBP for approval before submitting this form.
Relative is defined as parent or adoptive/step-parent, brother, sister, step-brother, step-sister, grandparent, step-grandparent, aunt,
uncle, step-aunt, step-uncle, niece, nephew, step-niece or step-nephew. This does not include cousin.
Full Name:____________________________
Relationship to student:________________________
Address (where student will be living in Australia) :_______________________________________________________
Date of birth:_________________________
Email address: _____________________________
Passport number : ____________________
Nationality (as per passport):____________________
Telephone:__________________________
____
Mobile:_____________________________________
Document checklist: Please attach confirmation that arrangement with relative over 21 has been approved by DIBP.
OR
Approved caregiver/guardianship services. Select your guardianship service and complete details below:
 International Student Alliance (ISA)
Name: ___________________________
A&J Student care services




Telephone: _______________________
Educare Services Australia



Mobile: ___________________________
Email:____________________________
Caregiver/guardian signature: __________________
OR
Family friend as caregiver/guardian
Family friends must have known the student’s family for a minimum of two years, maintain regular contact and be
prepared to provide care for the student to the same standard and quality as that provided by a
caregiver/guardianship service.
Full Name:____________________________
Relationship to student:________________________
How long have you known the family: _________years and ________ months
Address:_________________________
Visa type: _________ Expiry: ___________________
Email : __________________________
Nationality (as per passport):____________________
Telephone:________________________
Mobile:_____________________________________
NOTE: Before a family friend can be approved as a caregiver/guardian, they must be interviewed by Monash. If the student
will be living with the family friend, a home inspection is also required. There is a charge of $300 for this service which will be
billed separately.
Document checklist (please ensure the following documents are submitted together with this form:
 Copy of Statutory Declaration of family friend (if applicable)
 *Certified copy of photo ID of family friend (must bear signature)
Certification * Monash approved certified copy process.
Privacy statement:
The information on this form is collected for the purposes of assessing your accommodation and welfare arrangements. You have
the right to access personal information that Monash University and Monash College hold about you, subject to any exceptions in
relevant legislation. If you wish to seek access to your personal information or inquire about the handling of your personal
information, please contact the Monash College Privacy Officer at [email protected]
monashcollege.edu.au
CRICOS provider: Monash College 01857J
ACN: 064 031 714
Section 4. Change of accommodation
Important: A student living in inappropriate or unauthorised accommodation may be reported to the
Department of Immigration and Border Protection, who have the right to cancel the student’s visa.
Change of accommodation from DD / MM / YYYY
✓ Please tick and complete only one option
Monash College pre-approved
 Urbanest Melbourne Central
Homestay (non Monash)
This type of accommodation
cannot be approved by a family
friend as a caregiver/guardian.
 Homestay Accommodation Services
(HAS)
Family friend
The family friend listed below must be the
approved caregiver/guardian; an inspection
of accommodation is required.
Name of adult:
Name of provider
Date of birth:
Monash Residential Services
Name of contact person/host
Relationship to student:
Albert House
Address:
Relationship since:
Arrow on Swanston (long-term
Address:
apartments only)
Dudley House
Unilodge on A’Beckett (U18 hostel only)
Telephone:
Email:
Telephone:
Mobile:
Parent name ____________________
Parent Name __________________
Email:
Parent Name __________________
Parent signature _________________
Parent signature ________________
Parent signature ________________
Monash approved caregiver/guardianship
service signature
Monash approved caregiver/guardianship
service signature
_________________________________
_________________________________
Monash approved caregiver/guardianship
service signature
____________________________
Note: For non-Monash homestay or family friend accommodation, an approved person aged over 21 must live in the
same premises.
Document checklist You must submit the following documents with this form:
 Copy of letter of confirmation of accommodation (not required if accommodation is with family friend);
 Copy of Statutory Declaration of family friend (if applicable)
 *Certified copy of photo ID of family friend, if applicable (must bear signature)
Certification * Monash approved certified copy process.
Privacy statement:
The information on this form is collected for the purposes of assessing your accommodation and welfare
arrangements. You have the right to access personal information that Monash University and Monash College
hold about you, subject to any exceptions in relevant legislation. If you wish to seek access to your personal
information or inquire about the handling of your personal information, please contact the Monash College Privacy
Officer at [email protected]
monashcollege.edu.au
CRICOS provider: Monash College 01857J
ACN: 064 031 714