APPLICATION FORM

PERSONAL DETAILS (INCLUDING FULL LEGAL NAME)

TitleMrMissMsMrs

GenderMaleFemaleOther

Family NameSurname

First Name *

Middle Name

Preferred Name

Date of Birth

Day/Month/Year

COURSE AND DATE OF COMMENCEMENT

Intake

202302 JAN06 FEB03 APR08 MAY03 JULY07 AUG02 OCT06 NOV

202402 JAN05 FEB01 APR06 MAY01 JULY05 AUG01 OCT04 NOV

202506 JAN10 FEB07 APR12 MAY07 JULY11 AUG06 OCT10 NOV

COURSE/S YOU ARE APPLYING FOR

BSB40520 Certificate IV in Leadership and Management
Duration : 52 WEEKS ( 40 WEEKS STUDY )BSB50420 Diploma of Leadership and Management
Duration : 75 Weeks ( 60 Weeks Study )BSB60420 Advanced Diploma of Leadership and Management
Duration : 62 Weeks ( 50 Weeks Study )

EDUCATIONAL DETAILS

Are you still enrolled in secondary or senior secondary education?YesNo

What is your highest COMPLETED school level?Completed Year 12Completed Year 11Completed Year 10Completed Yr. 9 or equivalentCompleted Yr. 8 or lowerNever attended school(Not inclusive of higher education)

In which year did you complete this school level?(must be answered - even if education was completed overseas)

If still attending school, name of school:

Previous secondary school (if applicable)

Are you seeking Recognition of Prior Learning or Credit Transfer?YesNo

Evidence of EnglishIELTSTOFEL iBTPTEOtherScore

YOUR CONTACT DETAILS

Home Phone

Mobile Phone

Work Phone

Email *

Alternative email address (optional)

Preferred Contact Methodvia Mobile Phonevia Emailvia Post (address)

Your Emergency Contact

Name

Relationship

Home Phone

Mobile Phone

Work Phone

UNIQUE STUDENT IDENTIFIER (USI)

From 1 January 2015, we can be prevented from issuing you with a nationally recognised VET qualification or statement
of attainment when you complete your course if you do not have a Unique Student Identifier (USI). In addition, we are
required to include your USI in the data we submit to NCVER. If you have not yet obtained a USI you can apply for it
directly at http: www.usi.gov.au/create-your-USI/ on computer or mobile device. Please note that if you would like to
specify your gender as 'other' you will need to contact the USI Office for assistance.

Enter your USI

WHAT IS THE ADDRESS OF YOUR USUAL RESIDENCE?

Please provide the physical address (street number and name not post office box) where you usually reside rather than
any temporary address at which you reside for training, work or other purposes before returning to your home.
If you are from a rural area use the address from your state or territory's 'rural property addressing' or 'numbering' system
as your residential street address.
Building/property name is the official place name or common usage name for an address site, including the name of a
building, Aboriginal community, homestead, building complex, agricultural property, park or unbounded address site.

Building/property name

Flat/unit details

Street or lot number

Street name

Suburb, locality or town

State/territory

Postcode

AUSTRALIAN CITIZENSHIP STATUS

Australian CitizenNew Zealand CitizenPermanent Resident

Other

DISABILITY

Do you consider yourself to have a disability, impairment, or long-term condition?YesNo

If yes, please indicate the areas of disability, impairment, or long-term condition. You may indicate more than oneHearing/deafPhysicalIntellectualAcquired brain impairmentMental illnessLearningVisionMedical condition

Other

APPLICANT’S DECLARATION

Upload Documents

Drag and Drop (or) Choose Files

Checklist (Please submit all below evidence with the Application

Have You?Completed all sections of this application for?Attached/enclosed certified copies of your Qualification?Attached/enclosed are any other certified documentsAttached/enclosed are certified copies of your Passport and VisaAttached/enclosed are certified copies of English language proficiency?

I declare *

that the information and documents I have provided in this application are true and correct.
that I have access to sufficient funds to support my study and living cost for myself and my dependent (if any) while studying
at United International College.
that I personally signed this application form myself.
that I agree to abide by the rules of United International College for admissions, fee payment, attendance and course progression.
that I have read the student handbook on United International College website.
that I will inform United International College immediately of any changes to the information I have provided in this application form.

I understand *

that I may be contacted by United International College staff to clarify the information I have provided in this application form.
that the information collected in this form is used to determine whether my application to my preferred Course will be accepted.
that the information I have provided is correct and complete in every detail, and I understand that inaccuracies or omissions may result in nonacceptance or cancellation of enrolment at any time.
that United International College may make an enquiry to relevant organisation about my submitted documents and
information that I provided in this application.
that fully about the course and its contents including entry requirement, tuition fee, delivery location, campus facilities and
learning resources. I acknowledge and agree that this is an application only to study at United International College (i.e. there is no guarantee of a place); and, if an offer is made to me my acceptance is subject to the terms and conditions set out in the Letter of Offer.
I acknowledge that I have read the above and understand the information provided by United International College.