A. PERSONAL DETAILS
Student ID
S00xxxx
Nickname
example: English name / How you want teachers call you in class?
Given Name (as shown on passport)
*
Passport English Name
Family Name (as shown on passport)
*
Passport English Name
Have you renewed your passport in the last 3 months?
*
Yes
No
Passport Number
*
B. NEW CONTACT DETAILS
I would like to update (multiple choices)
*
Email address
Mobile
Address (Australia)
Other (please specify)
Emergency contact details
Email address
*
Confirmation Email
example@example.com
Australia Mobile
*
-
+61
New Address (Australia)
*
Unit/Street/Suburb/Postcode/State
Other Please specify
C. NEW EMERGENCY CONTACT DETAILS
Relationship to you
*
Father / Mother / Friend/ Partner
Name
*
Given Name
Family Name
Email Address
*
example@example.com
Mobile
*
-
+61
Phone Number
Address (Australia)
*
Unit/Street/Suburb/Postcode/State
D. Declaration
I declare that all information provided in this form is accurate and truthful.
Student Signature
*
Date
*
/
Day
/
Month
Year
Date
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