Student Applicaon 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 aendance: _________________________________________________________________________________________________
USQ Undergraduate Program being applied for (e.g. Bachelor of Arts, Bachelor of Science, etc.):
Preferred study locaon (Toowoomba, Springeld, Ipswich, Online) ______________________________________________________________
Does QTAC applicaon preference match the preference listed above?
If no, please ensure this is updated prior to your applicaon being submied to USQ.
5.0 OTHER DETAILS
This informaon is collected for reporng purposes and will not aect the outcome of your applicaon.
Do you idenfy as?
Torres Strait Islander
Aboriginal and Torres Strait Islander
Is English your rst language?
No – If no, my rst language is: ______________________________________________________
What is your residency status in Australia? Tick one of the following:
Possess a permanent resident visa (excluding New Zealand Cizens)
New Zealand Cizen (or diplomat or consular representave)
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 informaon only for the purposes of administering student
and prospecve student admissions, enrolment and educaon. The informaon collected is condenal and will not be disclosed to
third pares without your consent, except to meet government, legal or other regulatory authority requirements. For further informaon
7.0 STUDENT CHECKLIST
All secons of the form completed
Applicant declaraon signed (secon 8.0)
Submied online quesonnaire if applying for a teaching program
Aached 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 informaon supplied herein is true and complete. I agree to allow my Early Oer outcome to be released to my school
by the University of Southern Queensland.
Applicant signature: __________________________________________________________________________ Date: ______/______/________
¤ End of Applicaon for students who have successfully completed a USQ Head Start course
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