Expression of Interest
Preliminary Application Form
1. Personal Details
Title
Mr
Miss
Ms
Mrs
Dr
Other
Name
First Name
Middle Name
Family Name
Preferred Name
Date of Birth
/
Day
/
Month
Year
Gender
Male
Female
Unspecified
Country of Birth
Country of Citizenship
First Language
Permanent Address
Street Address
Street Address Line 2
Suburb
State / Province
Postal / Zip Code
Country
State
Please Select
SA
VIC
NSW
WA
QLD
NT
TAS
Postcode
Phone
Personal Email
Are you of Aboriginal or Torres Strait Islander origin?
No
YES, Aboriginal
YES, Torres Strait Islander
2. Education and Career Background
Which best describes your main reason for study?
To get a job
To try for a different career
To get a better job or qualification
It was a requirement of my job
I wanted to get extra skills for my job
To get into another course of study
Personal interest
Self development
Other
Are you currently enrolled in secondary school?
YES
NO
What is your highest COMPLETED secondary school level?
Year 12
Year 11
Year 10
Year 9 or lower
In which year did you complete this?
Secondary School you attended
Have you successfully completed any of the following qualifications?
YES
NO
If YES, please indicate which ones:
Postgraduate qualification
Grad Cert/Grad Dip
Bachelor Degree
Associate Degree/Advanced Diploma
Advanced Diploma
Diploma
Certificate IV
Certificate III
Certificate II
Other
Full name of highest tertiary qualification achieved
Tertiary institution where your qualification was completed
The year in which your highest tertiary qualification was completed
Declaration and Signature
I declare the information I have supplied on this form to be true and complete
YES
Date
/
Day
/
Month
Year
Signature
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