STUDENT DETAILS
Name *
Name
Date of Birth *
Date of Birth
Mobile *
Mobile
ie 042 312 3456
Home Phone
Home Phone
RESIDENTIAL ADDRESS
Residential Address *
Residential Address
POSTAL ADDRESS
Same as Residential Address
Postal Address
Postal Address
EMERGENCY CONTACT DETAILS
Name *
Name
Mobile *
Mobile
Home Phone
Home Phone
Address *
Address
CITIZENSHIP DETAILS
LANGUAGE
1 = poorly 10 = very well
INDIGENOUS STATUS
DISABILITY
EMPLOYMENT
HIGH SCHOOL EDUCATION
TERTIARY EDUCATION
UNIQUE STUDENT IDENTIFIER
ENROLMENT DETAILS
Course *
You may select more than one course.
If applicable
How did you hear about us? *
DECLARATION
I declare that... *
GUARANTEE
(from parent/guardian is Applicant is under 18 years)
Name
Name
Mobile
Mobile
Address
Address