Alternate Context Professional
Experience Application Form
Please complete all fields below
and submit your application form by email
to for consideration by 29 October 2018
1. Full Name:
2. USQ Student Number:
3. USQ Student Email:
4. Contact Telephone Number:
5. Course:
6. Campus:
7. Year Level
First year
Second year
Third year
Fourth year
8. Preferred Location:
9. Are you currently enrolled in EPP3100?
10. Why do you want to participate in a rural school placement?
11. What personal interests, skills, and experiences do you bring to this
12. How could you contribute to school and/or community life in a rural
context (e.g. after school activities, sporting skills, musical abilities, drama)?
13. Briefly describe any experiences you have had in diverse settings (locally or
internationally). How could this experience contribute to your learning and
participation in an alternate professional experience program?
14. Is there any further information you would like to offer that would support
your application?
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