Aboriginal Pathway Program (APP) Application Form

NOTE, APPLICATIONS ARE NOW OPEN FOR 2020. IF YOU HAVE ANY QUESTIONS, PLEASE CONTACT app@unisa.edu.au

 

 

APP Program Region I am applying for:

 

 

 

 

I would like to commence in:

Please Note: You will be contacted about your preferred commencement date.

 

 

 

 



 

 

Application Information

 

 

 

Title

 

 

First/Given Name

 

 

Family/Last Name

 

 

Preferred First Name:

 

 

Gender

 

 

 

 

 

Date of Birth (DD/MM/YYYY)

 

 

Citizenship Status

 

 



 

 

Contact Details

 

 

 

Student Home Address

 

 

Student Postal Address (if different)

 

 

Home Phone Number

 

 

Mobile Phone Number

 

 

Email Address

 

 



 

 

High School Information

 

 

 

Have you completed year 12?

 

 

 

 

 

 

 

 

Where did your complete your last year of school?

 

 

 

 

 

Name of School:

 

 



 

 

Higher Education Studies

 

 

 

Have you previously completed any higher education studies?

 

 

Name of Award

 

 

Year Commenced

 

 

Year Completed

 

 



 

 

Australian Government Statistics

 

 

 

In which country were you born?

 

 

 

 

 

Is English your first language?

 

 

 

 

 

Are you of Aboriginal or Torres Islander descent?

 

 

Do you have a disability?

 

 



 

 

Application Submission

 

 

 

 

I declare that, to the best of my knowledge, the information provided by me is true and complete in every way.

 

I acknowledge that the University of South Australia may vary or reverse any decision regarding admission or enrolment, made on the basis of incorrect or incomplete information provided by me.

 

I authorise the University of South Australia to make enquiries about the details associated with this application, including but not limited to obtaining from the institutions concerned whatever details of my academic record it considers necessary.

 

 

 

 

 



 

 

Informed Consent Statement

 

 

 

 

I understand that:

 

 

 

∙ The University of South Australia is collecting information in this form for the purpose of assessing my entitlement to Commonwealth assistance

 

under the Higher Education Support Act 2003 and allocation of a Commonwealth Higher Education Student Support Number (CHESSN) to me;

 

∙ The University of South Australia will disclose this information the Department of Education, Employment and Workplace Relations (DEEWR) for those purposes;

 

∙DEEWR will store the information securely in the Higher Education Information Management System;

 

∙ DEEWR May disclose the information to the Tax Office; and

 

∙ The University of South Australia and DEEWR will not otherwise disclose the information without my consent unless required or authorised by law.

 

∙ The University will provide me with information about its products, services and events. I understand that I can review how my personal information is collected and withdraw my consent at any time by visiting the University's Privacy Policy.

 

∙ The University will provide me with information about its products, services and events.

 

∙ I can review how my personal information is collected and withdraw my consent at any time by visiting the University's

Privacy Policy

.

 

 

 

Note: once you have submitted your application, changes may only be made by contacting UniSA please ensure that your application is completed before submitting.

 

 

 

 

 

Applicant Signature

 

 

Date (DD/MM/YYYY)

 

 

 


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