Aboriginal Pathway Program (APP) Application Form

A print version of this form is available here.

Application Program Details

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 
First/Given Name
Family/Last Name
Preferred First Name:

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

Areas of study and research

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