ACCHS_USI Consent Form

Unique Student Identifier (USI) Consent Form
Important Information

To create a Unique Student Identifier (USI) you will need to use a valid Australian form of ID from the list. Your proof of ID will allow us to make sure that your records and results always go to your USI account and not someone else's with similar details. There might be someone who has the same name as you in the same city or town or someone with the same name might have the same date of birth. By using some details from a form of ID when you create your USI it allows us to identify you so we can make sure your USI is truly unique to you. If you don't have a valid form of ID please contact our staff for further assistance.
Student Name*

First NameLast Name
Date of Birth*

DayMonthYear
Date
Place of Birth*
City, Country
Address*

Street Address

Street Address Line 2

City / SuburbState / Province

Postal / Zip CodeCountry
Phone Number*
Email Address*
example@example.com
Student Signature*

Clear
Date

DayMonthYear
Date
Office Use Only
Admin Officer
USI Created
Date

DayMonthYear
Date
Should be Empty:

Unique Student Identifier (USI) Consent Form