Application Form

Application Form

Personal Details - Step 1 of 10
DID YOU ENGAGE THE SERVICES OF AN AGENT IN APPLYING TO PBC? *
WHAT WAS THE NAME OF THE AGENT?
WHAT WAS THE NAME OF THE AGENCY?
Personal Details*

TitleFirst NameMiddle NameLast Name
PREFERRED NAME
MARITAL STATUS *
PREVIOUS FAMILY NAME
DATE OF BIRTH*

MonthDayYear
Date
GENDER*
USI*
Please obtain your USI from: www.usi.gov.au
EMAIL*
example@example.com
MOBILE PHONE*
Please enter a valid phone number.
HOME PHONE
Please enter a valid phone number.
PERMANENT HOME ADDRESS*

Address Line 1

Address Line 2

CityState / Province / Region

Postal CodeCountry
IS YOUR TERM ADDRESS THE SAME AS YOUR PERMANENT ADDRESS?
TERM ADDRESS

Address Line 1

Address Line 2

CityState / Province / Region

Postal CodeCountry
ARE YOU OF ABORIGINAL AND/OR TORRES STRAIT ISLANDER DESCENT?

Personal Details (Continued)
COUNTRY OF BIRTH*
BIRTH CERTIFICATE OR PASSPORT*

An original or certified copy of your birth certificate or passport will have to be sighted by the college.
Cancelof
CITIZENSHIP*
DO YOU SPEAK A LANGUAGE OTHER THAN ENGLISH AT HOME?*
WHAT LANGUAGE DO YOU SPEAK AT HOME?
DO YOU HAVE A DISABILITY, IMPAIRMENT OR LONG TERM MEDICAL CONDITION WHICH MAY AFFECT YOUR STUDIES?*
PLEASE INDICATE:

HearingLearningVisionMedicalMobilityOther
OTHER CONDITION
PLEASE LIST ANY MENTAL HEALTH CONCERNS (IF NONE, PUT N/A)*
WOULD YOU LIKE TO RECEIVE ADVICE ON SUPPORT SERVICES,EQUIPMENT AND FACILITIES WHICH MAY ASSIST YOU?

Courses
WHICH COURSE YOU ARE SEEKING ADMISSION INTO?*
HAVE YOU PREVIOUSLY STUDIED AT PBC?*
WHEN?
WHEN DO YOU WISH TO BEGIN STUDY?*
eg Trimester 1, 202x
HOW ARE YOU INTENDING TO STUDY?*
Course Admission
WHAT IS YOUR HIGHEST LEVEL OF EDUCATION ACHIEVED?*
ON WHAT BASIS ARE YOU SEEKING ADMISSION?*

Higher School Certificate or equivalentSecondary Education, TAFE or equivalentHigher Education CourseProfessional QualificationMature AgeSpecial Entry
TRANSCRIPT AND CERTIFICATE

Please provide a colour PDF copy of your transcript and your certificate of completion (if you have one).
Cancelof
EVIDENCE

Please provide evidence of your professional qualification
Cancelof
EVIDENCE

Your STAT score is required, plus a copy of your passport or birth certificate
Cancelof
SPECIAL ENTRY

Please provide your resume and any non-accredited certificates
Cancelof
UPLOAD TESTIMONY AND DIGITAL PHOTO HERE

Please provide a one-page testimony and digital photo. The digital photo can be one taken on an iPhone, but cannot be a screen shot.
Cancelof

Previous Education
Secondary Level
SCHOOL ATTENDED*
STATE*
POSTAL CODE
WHAT IS YOUR HIGHEST COMPLETED SECONDARY SCHOOL LEVEL? (OR EQUIVALENT)*
IN WHAT YEAR DID YOU LEAVE/GRADUATE FROM SECONDARY SCHOOL?*
UAI / TER / OP SCORE
NAME OF THE TOWN/SUBURB WHERE YOU LIVED IN YOUR LAST YEAR OF SECONDARY SCHOOL
POSTCODE
WERE THESE STUDIES OVERSEAS?
COUNTRY OF STUDIES
LANGUAGE OF STUDIES
ACADEMIC RECORD OR AWARD

Please include a copy of your academic record or award.
Cancelof
Tertiary Level Studies
INSTITUTION STUDIED AT
SECOND QUALIFICATION: INSTITUTION STUDIED AT
Further Details
ARE YOU CURRENTLY STUDYING ELSEWHERE?*
INSTITUTION
COURSE NAME
COURSE MODE
WHAT WAS YOUR MALE PARENT/GUARDIAN’S HIGHEST EDUCATIONAL ATTAINMENT?*
WHAT WAS YOUR FEMALE PARENT/GUARDIAN’S HIGHEST EDUCATIONAL ATTAINMENT?*
English Proficiency
IS ENGLISH YOUR FIRST LANGUAGE?*
If English is not your first language, you may be required to complete an IELTS test.
HAVE YOU COMPLETED AN ENGLISH LANGUAGE TEST?*
TEST NAME
TEST SCORE
TEST DATE
/
/
TEST RESULTS

Cancelof
Credit for Previous Study
WOULD YOU LIKE TO APPLY FOR CREDIT FOR PREVIOUS STUDY

Financial Information

Note: Tuition fees are required before each semester.
HOW DO YOU GENERALLY PLAN TO PAY FOR YOUR STUDY?*

Cash/ChequeCredit Card (Visa)Fee HelpCredit Card (Mastercard)Bank TransferOther
Other
YOUR TAX FILE NUMBER*
HAVE YOU USED HECS/FEE-HELP BEFORE?*

Church Information
FIRST NAME*
LAST NAME*
THE CHURCH THAT YOU ATTEND*
PERIOD OF ATTENDANCE*
CHURCH INVOLVEMENT*

Reference Information
FIRST NAME*
LAST NAME*
Phone Number*
Please enter a valid phone number.
EMAIL*
example@example.com
FIRST NAME*
LAST NAME*
Phone Number*
Please enter a valid phone number.
EMAIL*
example@example.com

Next of Kin
FIRST NAME*
LAST NAME*
RELATIONSHIP TO YOU*
Phone Number*
Please enter a valid phone number.
EMAIL*
example@example.com

DO YOU WANT TO APPLY TO USE OUR ACCOMMODATION?*
Please submit an accommodation application form.

Declarations
Withdrawal and Refund

Students may withdraw from courses without academic penalty only if notice of withdrawal is submitted in writing to the Registrar by 4pm on the Census Date. Withdrawal prior to 4pm on the Census date will ensure refund of the tuition fee. Tuition fee will not be refunded beyond this time. See the Perth Bible College Refund Policy for further details.
CONSENT*

I understand and accept the withdrawal and refund arrangements of Perth Bible College
Privacy Legislation

Perth Bible College requires the information requested of you in this form in order to provide you with education services and to cater for particular student’s needs. If you do not provide all the relevant information, we may not be able to provide such services and to assess your academic progress.Please also note that Perth Bible College may provide your personal information and sensitive information to third parties (eg educational institutions such as universities, colleges and accreditation bodies and Australian government bodies such as DEEWR, Centrelink and the Department of Immigration and Citizenship, Tuition Assurance Scheme, ESOS Assurance Fund Manager) in order to provide you with education services and assess your academic progress or suitability. You can request access to your health and personal information by contacting the Privacy Officer.
CONSENT*

I understand and accept the privacy legislation.
Declaration

I agree with the PBC Statement of Faith. I undertake to give the utmost attention to my studies, and to carry out such duties as are allotted me, to live for others at all times, and to abide by the College guidelines and policies at all times. I wish to be considered for entry into the program that I have nominated. I declare that the information that I have provided herein is true and accurate to the best of my knowledge.
CONSENT*

I agree
DATE*
Should be Empty:

Application Form

Course Admission

Previous Education

Secondary Level

Tertiary Level Studies

Further Details

English Proficiency

Credit for Previous Study

Financial Information

Church Information

Reference Information

Next of Kin

Declarations

Withdrawal and Refund

Privacy Legislation

Declaration