First Name:
Last Name:
Gender:
Street Address:
Suburb/Town:
PostCode:
State:
Phone Number:
Email:
Date of Birth:
Country Of Birth:
Year of Arrival:
Unique Student Identifier Number (USI):
Are you of Aboriginal or Torres Strait Islander Origin?:
How well do you speak English:
Do you speak a language other than English at home?:
Do you speak a language other than English at home? (please specify):
Do you have a disability, impairment or a long term condition?:
Do you have a disability, impairment or a long term condition? (please specify):
Highest completed school level:
Have you SUCCESSFULLY completed any of the following qualifications:
If YES, select ANY applicable:
Reason for Study:
Current Employment Status:
Choose Your Course:
Do you live in Western Australia?:
Are you currently working?:
Are you a secondary school student?:
Are you:
Apply for Skilled Capital Program:
Signature: