LIHE Student Information Form

Student Information Form
Student ID Number
Full Name

First NameLast Name
Date of Birth

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
USI
Year of arrival in Australia
Course
Contact Details in Australia
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship
Contact Details in Home Country
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship
Onshore Emergency Contact Details
Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Relationship
Student Declaration
I declare the following

- That the information provided by me on this form is true and correct

- That I attended LIHE’s Orientation Session

- That I have been provided with a link to the student handbook
Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty: