UC-START APPLICATION FORM

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