Document 6530179

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
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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
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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
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