2015 UQ Q Enhanced c Studies Program (ESP) P Sample Application Guide t d Below is an example of the questions you will need to answer to complete your ESP application online. Please note: This is NOT an official UQ ESP Application Form. Submitted copies of this document will not be accepted as an application. Please submit your application online. * Denotes required field Section 1 Name First Name * Last Name * (ie. first and middle) This must be the legal name that appears on your birth certificate/passport Middle Name Gender * Date of Birth * Are you of Aboriginal or Torres Strait Islander descent? * Yes N o Address Postal Address : Street / PO Box * State * Suburb/Town * Postcode * School Do you attend a Queensland school? * Yes No School Name* What is your Learner Unique Identifier Number (LUI)? * Your LUI is a 10‐digit number that the QSA uses to identify you – please check with your school or the QSA to find your LUI Contact Home Phone * Mobile Phone * Email * Please note: The email address you use as part of your application must be uniq ue to you. ie. an email address that is NOT shared by family members or others, please also ensure th at your spam filter will accept emails from addresses ending in @uq.edu.au 2015 UQ Enhanced Studies Program ‐ Sample Application Guide Page 1 of 3 Section 2 Citizenship Are you an International Student? * Yes No What is your Citizenship Status? *(Choose one ‐ If you were born in Australia and permanently live in Australia you will most likely be an Australian Citizen) Australian Citizen Australian Permanent Resident New Zealand Citizen Permanent Humanitarian Visa Holder Other Temporary Resident Holder of a Student Visa International Student Information Country of Permanent Residence * Postcode for Permanent Residence. * Country of Birth * Year of Arrival in Australia* Do you speak a language other than English at home? * Yes No If yes, what other language do you speak at home? * Parent/Guardian details Title * First Name * Last Name * Home Phone * Work Phone * Mobile Phone * Email Address * Relationship to Applicant * School Contact Information Please enter the contact details of your ESP School Contact. Your school contact may be a Guidance Officer, Year 12 Coordinator, Head of Department or Principal and will be responsible for monitoring your ESP progress. Title * First Name * Last Name * Position at school* Phone Number * Email Address * Medical Information This information is used only to provide advice and support services to students and will not affect your application Doyouhaveadisability,impairment,orlongtermmedicalconditionthatmayaffectyourstudies? * Yes No Please supply details of above medical condition or impairment. * Wouldyouliketoreceiveadviceonsupportservices,equipmentandfacilitieswhichmayassistyou? * Yes No 2015 UQ Enhanced Studies Program ‐ Sample Application Guide Page 2 of 3 Section 3 ESP Course PleasenominateafirstandsecondESPcoursepreference;youwillmostlikelybegivenyourfirstpreference ESP Course ‐ 1st Preference Course * Location (Campus) * Mode *(Internal – attend classes on campus, External – study online – not available for all courses) ESP Course ‐ 2nd Preference Course * Location (Campus) * Mode * Language Information If you have selected a language course, how many years have you been studying/speaking this language? * Please indicate your level of competency in this language: * Never previously studied Beginner Basic Intermediate Advanced/Fluent Native Speaker Privacy statement: The information on this form is collected for the primary purpose of assessing your application for the 2015 Enhanced Studies Program. Personal information may be disclosed to your school for verification of your studies to make an informed decision about the application. Otherwise your information will remain confidential and will not be disclosed to a third party without your consent unless disclosure is authorised or required by law. For further information please consult the UQ Privacy Management Policy at: https://ppl.app.uq.edu.au/content/1.60.02‐privacy‐management I accept: * Yes No To be considered for the Program, your Online Application Form and all supporting documentation must be received by UQ by no later than 5pm, Friday 31 October 2014. You will receive an email to confirm that your application has been received. It is your responsibility to contact the UQ ESP Coordinator by emailing [email protected] or by phone on (07) 3346 7762 if you have not received this confirmation email within two working days of submitting your application. 2015 UQ Enhanced Studies Program ‐ Sample Application Guide Page 3 of 3