1. STUDENT DETAILS
Name *
Name
Date of Birth *
Date of Birth
Mobile *
Mobile
ie 042 312 3456
Home Phone
Home Phone
2. RESIDENTIAL ADDRESS
Residential Address *
Residential Address
Are you living in NSW social housing; or is your household on the NSW Housing Register? *
3. POSTAL ADDRESS
Same as Residential Address
Postal Address
Postal Address
4. EMERGENCY CONTACT DETAILS
Name *
Name
Mobile *
Mobile
Home Phone
Home Phone
Address *
Address
5. CITIZENSHIP DETAILS
Are you on a Student Visa? *
6. LANGUAGE
1 = poorly 10 = very well
7. INDIGENOUS STATUS
Do you identify as Aboriginal or Torres Strait Islander *
8. DISABILITY
Do you have a disability, impairment or long term medical condition which may affect your studies? *
Are you a dependent child or spouse of a person in receipt of a disability support pension?
9. EMPLOYMENT
Do you have any previous work experience?
Please indicate welfare status: *
Are you an Employment Service Provider client; or do you have appropriate evidence of long term (12months) unemployed status?
10. HIGH SCHOOL EDUCATION
11. TERTIARY EDUCATION
Have you previously studied at the tertiary level *
Did you complete the course?
12. UNIQUE STUDENT IDENTIFIER
Do you have a unique student identifier (USI)? *
13. ENROLMENT DETAILS
Course *
You may select more than one course.
If applicable
Have you undertaken any Smart and Skilled qualification this calendar year? *
14. STUDENT DECLARATION
I declare that... *
15. PARENT OR GUARDIAN DECLARATION (IF STUDENT IS UNDER 18 YRS)
I declare that...
Name of Parent or Guardian (if applicant is under 18 yrs)
Name of Parent or Guardian (if applicant is under 18 yrs)
Mobile
Mobile
Address
Address