COLLEGE Student Application Form

COLLEGE Student Application Form Tertiary Preparation Program ? Program Code 1100

The Tertiary Preparation Program is open to Australian domestic students, New Zealand citizens and holders of a permanent visa for Australia who are over 18 years of age OR have completed year 12. Identification requisites apply.

January

May

September Intake

Personal Details ? All printing on application must be legible

Gender:

Male

Female

Other

D.O.B

/

Full Name: Surname:

First name:

Middle name:

Email:

Residential Address:

Phone:

Mobile:

Home:

/ Post Code:

Language and Cultural Diversity

What is your country of birth?

Australia

Other (please specify)

Are you an Australian citizen?

Yes

No, I have a permanent resident visa

No, I have a temporary visa

Are you a New Zealand citizen?

Yes

What is the language you speak mainly at home?

English

Other (please specify)

How well do you speak English?

Very well

Well

Not Well

Are you of Aboriginal or Torres Strait Islander origin? No

Yes Aboriginal

Yes Torres Strait Islander

Education

What is your highest COMPLETED education level:

Year 12 or equivalent

Do you have an OP or Rank score?

Yes/Score

No

Year 11 or equivalent

Year 10 or equivalent

Year 9 or equivalent

Year 8 or equivalent

In which YEAR did you complete that school level?

Are you still attending secondary school?

Yes

No

UQ College Admissions Only:

Date Received:

/

/ 20

Enrolment Number:

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COLLEGE Student Application Form Tertiary Preparation Program ? Program Code 1100

Qualification

Have you completed any qualifications since leaving school? If yes, please indicate which best describes your Qualification/s.

Yes

No

Certificate II

Diploma (or Associate Diploma)

Certificate III (or Trade Certificate)

Advanced Diploma or Associate Degree

Certificate IV (or Advanced Certificate)

Overseas Qualification

Bachelor Degree Please advise highest program of study:

Masters

Have you studied at any University for any period of time?

Yes

No

Have you ever been enrolled at The University of Queensland?

Yes

No

If yes to UQ, please tell us the year

and your student #

if known.

Study Reasons

Of the following categories, which BEST describes your main reason for undertaking this course / qualification? (Tick ONE box only)

To get into a Degree program in (identify Degree): To get into a VET program in: To change career to: For self-development, personal interest or other:

Employment Details

Of the following categories, which BEST describes your current employment status?

Full-time employee

Unemployed (seeking full-time or part-time work)

Part-time employee

Employer

Self-employed

Not employed (not seeking employment)

Disability

Do you consider yourself to have a disability, impairment or long-term condition?

Yes (please specify)

No

Hearing /Deaf

Intellectual

Medical Condition

Physical

Learning

Mental Illness

Other (please specify)

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COLLEGE Student Application Form Tertiary Preparation Program ? Program Code 1100

Other Needs

In order that we can best support you in your application to study, please list any other specific needs which may impact on your full participation in this course: e.g. religious requirements, carer's needs, etc. (Please specify)

Where did you hear about the Tertiary Preparation Program? (Please tick)

UQ College Website

School Counsellor

Word of Mouth

TSXPO

Local Signage (Billboard)

Newspaper advertisement

Friend or relative

QTAC

Other (please specify)

UQ Website

Facebook

UQ St Lucia Open Day

Centrelink

Checklist prior to sending in your application

? Australian / New Zealand Citizen ? One photo identification required Copy of Passport/Driver's Licence/Proof of Age card

? Holder of a Permanent Visa including a Permanent Humanitarian Visa Copy of Passport or IMMI Card and Visa or letter from Dept. of Immigration & Citizenship

? Under 18 ? additional information required - Copy of your Year 12 Statement of Results ? Post-secondary studies ? additional information required - Evidence of post-secondary studies undertaken ? Application has been signed

To lodge your application

Ensure that the application form has been fully completed and signed (Digital signature if submitting electronically), and any course entry requirement documents are included. Return your completed application by one of the following methods:

Email:

Select the Submit button at end of form and change subject to "TPP APP- insert your name" or, email to info@uqcollege.edu.au

Postal Address: UQ College, c/- The University of Queensland, St Lucia Q 4072

In Person:

UQ College, Building 82E, Seddon Building Level 3, Slip Road, St Lucia.

For any queries or additional information please contact UQ College on (07) 3346 8222 or visit our website at uqcollege.edu.au or Facebook uqcollege

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COLLEGE Student Application Form Tertiary Preparation Program ? Program Code 1100

Language, Literacy and Numeracy Test & Interview

A Language, Literacy and Numeracy Test is conducted for all applicants. This is followed by an Interview with a representative of UQ College. You will be contacted via phone and/or Email to arrange a convenient time. Please ensure your contact details remain current.

Privacy declaration

UQ College has a Privacy Policy to provide individuals with information about how we hold and use personal information, please contact the College for a copy of this policy. UQ College protects personal information based on the privacy principles in the Information Privacy Act 2009. UQ College may share a student's academic and personal details with The University of Queensland for the purpose of enrolment into an undergraduate program and ongoing contact during the undergraduate program. UQ College will provide all Australian government entities with information regarding the student as requested and in accordance with the relevant legislation.

Photography and media waiver

Should I be granted enrolment into the Tertiary Preparation Program, I give consent to UQ College to use any photograph or image of me for purposes of advertising, media publicity, publication, web display, general display or any other UQ College purposes in whole or in part. I understand that I do not have any interest in the copyright to the photograph(s) now or at any future time and state that I do not expect to receive any payment or consideration in respect of them. I release UQ College, its employees and agents from any liability (including consequential loss) connected with the publication, reproduction, release or other use of these materials.

Photography, Media Waiver and Application signature

Student Signature:

typed name is acceptable

Parent's Signature (if under 18): typed name is acceptable

Submit to UQC

Date: Date:

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