UC-START APPLICATION FORM - 2015 Please select one of the term dates from the options below: Term 1, 2015 (16 February – 30 May) Term 2, 2015 (10 August – 21 November) Term 3, 2015 (26 October – 29 January 2016) – Limited degrees available *UC-START commencement date is determined by student’s choice of degree. Please note: compulsory attendance is required at orientation. UC-Start fee is $3,520 plus a student services and amenities fee. Please write clearly in CAPITAL BLOCK letters. Personal details: Title DD Date of birth / MM / YYYY Gender Male Surname Given names Preferred name Are you an Australian citizen, permanent resident, or on a diplomatic passport? Yes No (If no, you cannot apply) Contact details: Address City State Postcode Telephone (BH) (AH) (M) Email Contact person (in case of emergency): Full Name Address City State Postcode Telephone (BH) (AH) (M) Relationship to you (eg. mother, father, uncle) Education results: ATAR result Secondary education – highest level achieved Year Institution attended Proposed degree at University of Canberra (please indicate your three choices in order of preference) 1 2 3 Female Government statistics – This section must be completed or your application will not be processed. What is your current citizenship status? (select only one) 1 – Australian citizen (including Australian citizens with dual citizenship) 2 – New Zealand citizen or a diplomat or consular representative of New Zealand, a member of the staff of such a representative, excluding those with Australian citizenship. (N.B. includes any such persons with Permanent Residence status). 3 – Student with Permanent Residence status but excluding those with New Zealand citizenship. 4 – Temporary entry permit or a diplomat or a dependant of a diplomat (except New Zealand) and residing in Australia during this teaching period or/ an International Student Visa Holder 5 – Citizenship other than 1,2,3,4. 6 – Humanitarian Visa Holder. Are you an Aboriginal Australian or Torres Strait Islander? NO YES, Aboriginal YES, Torres Strait Islander YES, Aboriginal and Torres Strait Islander What is your permanent residence status? 1 – You were born in Australia or you have not obtained permanent residency through immigration. 2 – You were granted permanent residency and/or commenced your course prior to 1 January 1996. You have not yet met residency requirements or first did so within a period of 12 months prior to your enrolment. 3 – You are a New Zealand citizen or you hold a permanent visa but are not residing in Australia. 4 – You were granted permanent residency and/or commenced your course after 1 January 1996. You have not yet met residency requirements and first did so more than 12 months prior to your enrolment. Cancellation and refund conditions: If you change your mind about studying at the University of Canberra College you should advise us in writing of this decision. We will agree to a refund if you meet one or more of the following conditions: a. You no longer require the course for entry because you have been offered direct entry to University; or b. You have changed your mind before the commencement of the course; or c. You are unable to start or continue in the course because of family illness or other special circumstances. Your eligibility for a refund will depend on when we have received advice of your decision to withdraw. • If your request to withdraw is before commencement of your study, we will refund you 100% • If your request to withdraw is before 5:00pm on Friday of week 4 (census date), you will be charged an administration fee of 10% and • If your request to withdraw is received after 5:00pm on Friday of week 4, you will not be eligible for any refund. Please note that any refund will be made payable to the person who originally paid the fees. Students with disabilities: If you consider your studies may be affected in some way by a disability, chronic medical condition or caring for a person with a disability, please indicate by ticking the box, so that your needs can be accommodated. Privacy statement: The University of Canberra College abides by the Information Privacy Principles set out in the Commonwealth Privacy Act 1988. The UC College will not disclose your personal information to others without your permission except as required by law. Within the UC College and the University of Canberra, access to your information is restricted to those staff who require it to carry out their responsibilities. Results of studies which you undertake at the College will be released only to those educational institutions to which you are seeking admission. Also, as part of your application to the University of Canberra an administration officer will provide information to the Commonwealth Government so that you can be allocated a Commonwealth Higher Education Student Support Number (CHESSN). Declaration: If I enrol in the course I will accept liability for fees. I have read and agree to abide by the University of Canberra College refund conditions noted above. I have read and accept the Privacy Statement on this form. Applicant’s Signature Date DD / MM / YYYY Application check list: Please note your application will not be processed unless you provide certified copies of your educational results. Certified copy of ATAR result References from work (optional) Copies of secondary education results Nominated 3 proposed degrees at University of Canberra Application signed Copies of traineeship records (if applicable) Birth Certificate or Australian Passport/Document evidence of Australian Citizenship/ Permanent Residency Status NB. You will be advised in writing if your application has been successful. Please allow 10 working days after submitting your application before contacting the UC College about application progress. For office use only: Student ID Subjects Groups Processing order Record information in sheet for UC-START Fee bill attached Enter in Callista Enclosures: map, orientation, information sheet, refund policy Offer letter Offer sent Filed Place in tray for fee checking Postal address: University of Canberra College University of Canberra ACT 2601 T 02 6201 2961 F 02 6201 5089 www.canberra.edu.au/college Street Address: University of Canberra College, Building 5, Level B UCCO0072 UC BUCC CRICOS#00212K