Diploma in General Studies

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1 Diploma in General Studies Application form semester 1, 2017 Applications for the diploma in General studies can also be submitted through the Victorian Tertiary Admissions centre (VTAc). closing date for THe submission of direct APPlicATions for semester 1, 2017: WEDNESDAY 08 FEBRUARY Applicants are encouraged to submit applications as soon as possible. PART A: Applicant details Applicant details (please complete all fields) Have you ever studied, or applied to study at the University of Melbourne? If yes, previous University of Melbourne student/application number:...(leave blank if not known) Title: Mr / Mrs / Ms / Miss / Other Family name:... Given name(s):... Former name (if applicable)*:... Date of birth:... (Day Month Year) Gender: Female / Male (please circle) Are you an Aboriginal or Torres Strait Islander? *If your name has changed or differs from that on any of your supporting documentation, you must provide legal evidence of your official change of name, such as a Marriage Certificate or a Change of Name Certificate. Cultural details (please indicate your citizenship and residency details)* o Australian citizen o Australian permanent resident: Please provide your country of birth..., your year of entry into Australia if applicable)..., and main language spoken at home... o New Zealand citizen o Permanent humanitarian visa holder: Please provide your country of birth..., your year of entry into Australia (if applicable)..., and main language spoken at home... * Please be advised that this course is currently only available to Australian citizens and permanent residents, permanent humanitarian visa holders, or New Zealand citizens. Proof of citizenship Applicants who receive an offer and enrol at the University of Melbourne are required to provide proof of citizenship. Australian citizens will need to provide details of either an Australian birth certificate, passport or certificate of citizenship. Australian permanent residents will require their visa details and New Zealand citizens will require their New Zealand passport. Address details Permanent address (required): State:... Postcode:... Contact details (required): Home phone:... address:... Postal address (if different from your permanent address): State:... Postcode:... Mobile phone:... PART C: Time commitment Are you applying to study: o Full-time o Part-time Page 1 of 5

2 PART D: Education Please complete this section according to the school you attended for Year 12 Secondary school name:.... Secondary school postcode: In which year did you complete Year 12? Study score in Year 12 English, English Literature, or esl*: ATAR/ENTER/TER*: *Please attach supporting documentation (original or certified copies of your academic transcript or statement of results). Other education (please provide details if you have undertaken any other educational courses) CoURse Name Institution Course length (years) year of completion results (if APPlicable) PART E: Employment If you are a mature age applicant, you must submit a resume with this application form. If you are a school leaver, please complete this section: Have you undertaken any paid employment? Position:..... Duration of work (specify years) Brief description of responsibilities: Employer name:. Approximate number of hours per week: Have you undertaken any voluntary work? Position:.... Duration of work (specify years): Brief description of responsibilities: Employer name: Approximate number of hours per week: PART F: Referees Please attach copies of letters of recommendation from two responsible people who are preferably not your relatives or school friends, and who have agreed to act as academic, professional, or extra-curricular referees for you. Please provide the names and contact details of these two referees below, as they may be contacted for confidential advice about your suitability for this course. 1. Title: Dr / Mr / Mrs / Ms / Miss / Other... Family name:...given name:... Position/title:...Relationship to applicant:... Address:... Telephone:... address: Title: Dr / Mr / Mrs / Ms / Miss / Other... Family name:...given name:... Position/title:...Relationship to applicant:... Address:... Telephone:... address:... Page 2 of 5

3 PART G: Statement of motivation Please provide a statement about your reasons for applying for the Diploma in General Studies (write your statement in the space below, or attach a separate document to this form): PART H: supporting documentation School leavers If you are a school leaver, please attach: o A statement of motivation (up to one page, detailing your reasons for applying) o Letters of recommendation from two referees (academic, professional, or extra-curricular) o Proof of ATAR/enTER/TER o Statement of Vce (or other Australian Year 12 program) results, including study score in Year 12 English/English Literature/esl o Special Entry Form (statement of disadvantage), if applicable. Mature age applicants If you are a mature age applicant, please attach: o A statement of motivation (up to one page, detailing your reasons for applying) o Letters of recommendation from two referees (academic, professional, or extra-curricular) o Proof of ATAR/enTER/TER (if applicable) o Statement of Vce (or other Australian Year 12 program) results, including study score in Year 12 English/English Literature/esl o A resume (maximum of 3 pages), detailing your activities since completing Year 12 o Special Entry Form (statement of disadvantage), if applicable. Page 3 of 5

4 PART I: Applicant declaration and signature 1. I declare that all the information I have submitted with this application is true and complete including: All the records of the academic results I have achieved at each and every secondary school or tertiary institution I have attended. 2. I hereby authorise the University of Melbourne (University) in its absolute discretion to make any enquiries, including obtaining official records from any education institution or tertiary admissions centre concerning my current or previous academic results, it believes are necessary. 3. I acknowledge that the failure to disclose my true and complete academic record may result in my being excluded from the University. I understand that in investigating the veracity of the information I have provided, the University of Melbourne may require me to repeat the biometric component of any English language proficiency test I have undertaken. 4. If I have misrepresented my past and/or present circumstances I acknowledge that the University may terminate my studies and that the University may terminate my studies at any stage during the course undertaken. 5. I understand that the University reserves the right to inform other education institutions if any of the material presented to support my application is found to be false or misleading. 6. I understand that if I am awarded a scholarship from the University I must not hold another equivalent award at the same time from the University or any other organisation. If I am awarded a scholarship from the University which is based on false or misleading information I have provided in my application (or subsequently), I will be required to repay to the University any scholarship/s that I have received. Scholarship benefits include living allowances, fee remission and travel allowances. 7. I agree to be bound by and comply with by the University s policy (as amended from time to time) on admission, fees payments and fees refunds outlined in Arrangements Relating to the Payment of Student Fees: 8. I understand that the personal information that I have provided in my application (or subsequently) may be released: To Australian Commonwealth and State agencies under the Education Services for Overseas Students (ESOS) Act 2000; To the Department of Education, Employment and Workplace Relations (DEEWR) and that DEEWR will collect and store my personal information in the Higher Education Information Management System; or As required to be disclosed by law. 9. I understand that at the time of enrolment I may be required to supply originals of any documents used to support this application. I acknowledge that all documents submitted become the property of the University of Melbourne and will not be returned. Name of applicant (please print):... Signature*:... Day... Month... Year... * Please note, unsigned applications cannot be processed. How to lodge your APPlication Please submit this form and all supporting documentation to: Ros Gall Head of Campus Dookie Campus, University of Melbourne Dookie VIC 3647 closing date for the submission of direct applications for the semester 1, 2017 intake: Wednesday 08 February Acknowledgement of your application The University will acknowledge receipt of your application via within one week. If you have any questions about your application, please call the Faculty of Veterinary and Agricultural Sciences on 13 Melb ( ), or send an via the online enquiries form: Page 4 of 5

5 UniversiTY of MelboURne privacy statement Privacy legislation The University of Melbourne has a statutory obligation to comply with the Information Privacy Act 2000 (Vic) and the Health Records Act 2001 (Vic) when collecting, using or handling personal information or health information ( information ). What we collect and why The University collects information about a student for a number of purposes. In the main, such purposes relate to the proper administration of an individual's course of study at the University, the University s internal planning requirements, and the organisation of relevant health and welfare programs. Student information is also collected for the purposes of fostering alumni relations and promoting University activities and under Commonwealth or State Government legislation for the purposes of government reporting and for the administration of, but not limited to, the Higher Education Loan Programme (HelP) and the Youth Allowance (Austudy and Abstudy). The University will collect information directly from the student him or herself wherever possible. Accuracy, security and storage of information The University holds information in both computer, and paper based records. It takes all reasonable steps to ensure that the information it holds is accurate and complete and that it is protected from misuse, loss, unauthorised access or disclosure. Use and disclosure of information The Office of the Provost is responsible for maintaining the information of currently enrolled students. The University will not use or disclose your information for purposes other than that for which it was collected, or for related purpose which you might reasonably expect, without your permission, unless it is permitted or required to do so by law. The University will not release any information it holds about you, including results, addresses or other information, to your relatives (including parents or spouse), without your consent. The University will not confirm that you are or have been a student of the University, except as outlined in this statement, unless you have a record of graduation, as that is a public document. The following are examples of instances where the University may be required by law or permitted to disclose your information: providing information to Centrelink; releasing statistical information to relevant government bodies such as the Department of Education, Employment and Workplace Relations (DEEWR) and the Office of Training and Tertiary Education; releasing relevant information to the Department of Immigration and Citizenship (DIAC), the Department of Education, Employment and Workplace Relations (DEEWR) and the Australian Taxation Office; providing information to the police where required by law; releasing your academic details to another tertiary institution or tertiary admission centre if you apply to transfer studies; providing a list of enrolled students to the returning officer or other appointed electoral bodies to enable students who wish to vote at elections for student organizations or student representatives to Council to be able to do so (but not for the purpose of contacting students for marketing or promotional purposes); releasing the names of recipients of prizes, scholarships or similar awards to the respective official student sponsors or scholarship providers; providing information in response to a subpoena or summons or a written demand from a government authority with the power to demand the information; protecting a student or someone else from a serious and imminent threat to their life or health releasing examination results, academic and administrative information, to another institution where the student is enrolled under an official student exchange, cross-institutional study, dual degree, shared teaching, industry or clinical experience or multi-institutional arrangement with that institution to facilitate the collaboration or arrangement; publishing examination results; and releasing to another tertiary institution or a tertiary admissions centre, information about a student s academic progress at this University and Research Training Scheme entitlement where relevant if a student applies to transfer to that other tertiary institution. On graduation from the University, students become University Alumni. The University (or external parties appointed by the University) will contact alumni for purposes which include alumni networking, providing graduates with services and event information through the University s Advancement Office. Access to personal information Access to and correction of your information are handled in accordance with the Freedom of Information Act 1982 (Vic). Data obtained via the Enrolment Questionnaire that is reported to the Commonwealth Government can be viewed (and, if necessary, corrected) at University Privacy Officer/Privacy policy The University's Privacy Officer is the University Secretary, Dr Christopher Stewardson. The Privacy Officer's website, contains the University's Privacy Policy and provides detailed information about the contact details, complaints procedures and other aspects of the University's privacy regime. Questions If you have an enquiry about your privacy rights in relation to the collection of information from students, please contact the University's Privacy Officer. INTellecTUAL PROPERTY For further information refer to: Copyright in this publication is owned by the University and no part of it may be reproduced without the permission of the University. PUblisHER Authorised by: Faculty of Veterinary and Agricultural Sciences Published by: Office of Admissions Copyright: The University of Melbourne, September 2014 CRicos PROVideR code: 00116K DISCLAIMER The University has used its best endeavours to ensure that material contained in this publication was correct at the time of printing. The University gives no warranty and accepts no responsibility for the accuracy or completeness of information and the University reserves the right to make changes without notice at any time in its absolute discretion. STATEMenT on PRIVACY PolicY When dealing with personal or health information about individuals, the University of Melbourne is obliged to comply with the Information Privacy Act 2000 and the Health Records Act For further information refer to: Page 5 of 5

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