Certificate Request

1. Personal Details
Name (as shown on Passport)*

First NameLast Name
USI - Unique Student Identifier*
Confirm your name matches your passport, USI account and student portal.
Student ID Number*
Email*
example@example.com
Mobile Number:*
Date of Birth*

DayMonthYear
Date
Mailing Address*
Important:
- The name on your USI account must match your passport exactly (including the order of your first name, middle name, and family name).
- If a certificate needs to be re-issued due to incorrect details, a re-issue fee will apply.
2. Qualification Details
Qualification 1*
Qualification 1 End Date*

DayMonthYear
Date
Qualification 2*
Qualification 2 End Date*

DayMonthYear
Date
Campus:*

BrisbaneSydneyMelbourne
3. Student Signature
Confirmation: I have verified the above information is accurate, and I understand that any incorrect information may delay the process of my certificate request.
I acknowledge & confirm:*

I confirm that my full name and details provided match my passport exactly. I understand that if the name is incorrect and a certificate re-issue is required, a reissue fee of $10 will apply.All my assessments submitted to trainers or via student portal.My fees are up to date and I have no outstanding fees.
Signature*

Clear
Date*

DayMonthYear
Today
*Please allow approximately 5 WORKING DAYS for processing this request from the date we received this form. Requests could take up to 20 WORKING DAYS(Not included term breaks) to be processed during the peak periods.
Should be Empty:

1. Personal Details

2. Qualification Details

3. Student Signature