EARLY OFFER
Student Applicaon Form
University of Southern Queensland | CRICOS QLD 00244B NSW 02225M TEQSA: PRV12081 usq.edu.au | Page 1 of 3
Instructions for application
This form is for use by year 12 students aending high school to gain early admission to the University of Southern
Queensland (USQ).
Place USQ #1 on your QTAC applicaon
Students must submit this applicaon as well as a QTAC applicaon.
Students applying for an Educaon program must also complete the online quesonnaire to meet the Non Academic
entry requirements. Details will be provided by QTAC when your QTAC applicaon is submied. This task must be
completed prior to submission of your Early Oer applicaon form.
Schools must ensure recommended applicaon forms are received by USQ no later than Friday 16 October 2020.
Use BLOCK LETTERS and ck boxes.
1.0 QTAC DETAILS
QTAC Applicaon Number
2.0 PRIOR CONTACT WITH USQ
Have you previously studied the Headstart program at the University of Southern Queensland?
No (go to step 3)
Yes
If yes, year of last enrolment: _________________________
Student ID number (if known):
3.0 PERSONAL AND CONTACT DETAILS
Family name: Given name:
Date of birth (DD/MM/YYYY): _____ / _____ / _________ Country of birth:
If not born in Australia, what year did you arrive in Australia? _________________________
Gender:
Male
Female
Other
Mobile phone number: Telephone number:
Email address (Not school or shared family email):
EARLY OFFER
Student Applicaon Form
University of Southern Queensland | CRICOS QLD 00244B NSW 02225M TEQSA: PRV12081 usq.edu.au | Page 2 of 3
4.0 EDUCATIONAL AND PROGRAM INFORMATION
Current school of aendance: _________________________________________________________________________________________________
USQ Undergraduate Program being applied for (e.g. Bachelor of Arts, Bachelor of Science, etc.):
______________________________________________________________________________________________________________________________
Preferred study locaon (Toowoomba, Springeld, Ipswich, Online) ______________________________________________________________
Does QTAC applicaon preference match the preference listed above?
Yes
No
If no, please ensure this is updated prior to your applicaon being submied to USQ.
5.0 OTHER DETAILS
This informaon is collected for reporng purposes and will not aect the outcome of your applicaon.
Do you idenfy as?
Aboriginal
Torres Strait Islander
Aboriginal and Torres Strait Islander
Not applicable
Is English your rst language?
Yes
No – If no, my rst language is: ______________________________________________________
What is your residency status in Australia? Tick one of the following:
Australian Cizen
Possess a permanent resident visa (excluding New Zealand Cizens)
New Zealand Cizen (or diplomat or consular representave)
Possess a temporary entry permit (eg student visa or temporary resident visa)
I am a dependent of a diplomat (except New Zealand)
Possess a permanent humanitarian visa and will reside in Australia during semester
Please specify visa type: _______________________________________________________________________________________________________
6.0 PRIVACY STATEMENT
The University of Southern Queensland collects, stores and uses personal informaon only for the purposes of administering student
and prospecve student admissions, enrolment and educaon. The informaon collected is condenal and will not be disclosed to
third pares without your consent, except to meet government, legal or other regulatory authority requirements. For further informaon
visit usq.edu.au/privacy.
7.0 STUDENT CHECKLIST
All secons of the form completed
Applicant declaraon signed (secon 8.0)
Submied online quesonnaire if applying for a teaching program
Aached a copy of Year 11 report card
8.0 APPLICANT DECLARATION
I agree to obey the polices, guidelines and rules of the University of Southern Queensland as far as they may apply to me.
I declare that the informaon supplied herein is true and complete. I agree to allow my Early Oer outcome to be released to my school
by the University of Southern Queensland.
Applicant signature: __________________________________________________________________________ Date: ______/______/________
¤ End of Applicaon for students who have successfully completed a USQ Head Start course
click to sign
signature
click to edit
EARLY OFFER
Student Applicaon Form
University of Southern Queensland | CRICOS QLD 00244B NSW 02225M TEQSA: PRV12081 usq.edu.au | Page 3 of 3
9.0 SCHOOL CHECKLIST (For Non Head Start Students)
Copy of Year 11 report card aached
Submit completed applicaon prior to closing date, refer to 11.0 for lodgement details
Applicaon assessed by school for meeng entry rank and prerequisite study requirements.
The School Principal is responsible for assessing applicants for the Early Oer based on their potenal to succeed and accepts
full accountability for ensuring students that are approved meet prerequisite requirements and have the ability to succeed
academically at terary level. School Principal to submit completed applicaon on student's behalf.
If student is applying for a teaching program, have checked that student has submied their online quesonnaire through QTAC
All secons of the applicaon form completed
School approval signed, checked applicant has signed declaraon
10.0 SCHOOL APPROVAL
Principal to complete
By signing this form, you are subming your recommendaon and taking full responsibility for ensuring students who are approved will
meet all requirements and prerequisites and will have the ability to succeed within a bachelor level of study.
If the applicant has applied for any of the following programs they will be made a condional oer upon conrmaon that these
requirements are met:
Bachelor of Music, Bachelor if Theatre, Bachelor of Visual Art and Bachelor of Creave Arts (subject to a successful audion or porolio)
Bachelor of Educaon (Early Childhood), Bachelor of Educaon (Primary) and Bachelor of Educaon (Secondary)
USQ will conrm all requirements have been met once year 12 results are released in December.
Approver name: ______________________________________________ Approver tle: ______________________________________________
Approver signature: ____________________________________________________________________________Date: ______/______/________
11.0 LODGEMENT
All school approved applicaons for USQ Early Oer must be received by USQ no later than Friday 16 October 2020. Applicaons
received by USQ aer this date will not be accepted. Ensure all applicaons are accompanied by a copy of the student’s Year 11
report card.
Lodgment:
Please click here to submit or email study@usq.edu.au, with subject line: Early oer applicaon
click to sign
signature
click to edit
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