Yes. Yes. Yes. English. How well do you speak English? Very well Well Not Well. Date Received: / /20 Enrolment Number: Science

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1 STUDENT APPLICATION FORM May 2018 Intake Course Details: Tertiary Preparation Program - Program Code 1100 Personal Details All printing on application must be legible Gender: Male Female D.O.B. Full Name: Surname: First Name: Middle Name: Residential Address: Phone: Home: Mobile: Language and Cultural Diversity Are you of Aboriginal or Torres Strait Islander origin What is your country of birth? Are you an Australian citizen? Are you a New Zealand citizen? What is the language you speak mainly at home? No Aus Yes Yes English Yes Aboriginal / / Post Code: Yes Torres Strait Islander Other (please specify) No No I have a I have a temporary visa permanent resident visa Other (please specify) How well do you speak English? Very well Well Not Well UQ College Admissions Only: Date Received: / /20 Enrolment Number: English Math A Math B Bus Mgmt Economics Beh. Science Biology Chemistry Research H.E.D. QF009 Page 1 of 5

2 Education What is your highest COMPLETED education level: Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or equivalent Do you have an OP score? Yes No Score Do you have a rank? Yes No Score In which YEAR did you complete that school level? Are you still attending secondary school? Name of the last school you attended: Yes No Have you completed any qualifications since leaving school? Yes No If yes, please indicate which best describes your Qualification/s. 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 Masters Please advise highest program of study: Have you ever been enrolled at The University of Queensland? Yes No If yes, 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 : 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) QF009 Page 2 of 5

3 Entry Requirements A Language, Literacy and Numeracy test is conducted for all applicants. Applicants must be 18 years of age or have completed Year 12. The Tertiary Preparation Program is open to Australian domestic students as well as New Zealand citizens and holders of a permanent visa for Australia. Please indicate one of the provided dates below to sit your Language, Literacy & Numeracy Test. Note these dates have not been finalised. TBA 10am 12noon at The University of Queensland, St. Lucia Campus Saturday - February 10, 2018 Saturday - March 10, 2018 Disability Do you consider yourself to have a disability, impairment or long-term condition? Yes (please specify below) If yes, please indicate the area/s or disability, impairment or long-term condition. Hearing/Deaf Physical Vision No Intellectual Learning Medical Condition Mental Illness Other (please specify) Other 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, transport issues etc. Where did you hear about the Tertiary Preparation Program? (please tick) UQ College Website TSXPO Friend or relative University of Queensland (Website) UQ St Lucia Open Day School Counsellor Local signage (billboard) QTAC Facebook Centrelink Word of Mouth Newspaper advertisement Other QF009 Page 3 of 5

4 Checklist prior to sending in your application Please ensure that you have provided the required credentials alongside your application. Australian/New Zealand Citizen o Copy of your Australia/New Zealand Birth certificate/passport/medicare Card Holder of a Permanent Visa including a Permanent Humanitarian Visa o Copy of Passport/Visa/or letter from Dept. of Immigration & Citizenship Proof of age e.g. passport/birth certificate/driver s licence If under 18, copy of your Year 12 Statement of Results Any evidence of post-secondary studies undertaken Preference of listed testing date To lodge your application Ensure that the application form has been fully completed and signed, two forms of identification are included and that you have selected your preference of testing date. Return your completed application by one of the following choices: Postal Address: In Person: UQ College C/- The University of Queensland, St Lucia Q 4072 UQ College, Building 82E, Seddon Building Level 3, Slip Road, St Lucia. info@uqcollege.edu.au For any queries or additional information please contact UQ College on (07) or visit our Website at or Facebook Please Note: Age of entry is 18 or have completed year 12 to be eligible for enrolment. Completion of a LLN Test and proof of age is required. QF009 Page 4 of 5

5 Privacy Declaration UQ College protects personal information based on the privacy principles in the Information Privacy Act 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 Signature Date QF009 Page 5 of 5