Aboriginal Pathway Program (APP) Application Form

Application Program Details

APP Program Region I am applying for:





  
I would like to commence in:


  


  
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.
  
 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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