This document must be completed in full by all applicants. Please use BLOCK print and black or blue pen.
IMPORTANT NOTE: It is essential to confirm the applicant’s identification and record correct name. PRIVACY LEGISLATION/POLICY APPLIES.
Student Details (Please mark appropriate ¨ withr)
Identification document(s): ¨ DRIVERS LICENCE ¨ PASSPORT ¨ BIRTH CERTIFICATE (Only one type of ID required)
Family Name: / Given Name/s: / Preferred Name/s:
Telephone / Mobile: / Gender: ¨ Male ¨ Female / Date of Birth:
Home Address: / Suburb: / State: / Postcode:
Email Address (required):
Employer Details (if applicable)
Organisation Name: / Employment status: ¨Full-time ¨Part-time ¨Casual ¨Self-employed ¨Not currently employed
Postal Address: / Suburb: / State: / Postcode:
Telephone / Mobile: / Email Address: / Manger(s) Name:
Emergency Contact Details
Name: / Relationship:
Address: / Suburb: / State: / Postcode:
Telephone: / Mobile: / Email:
Resident Status: (please tick one)
¨ Australian Citizen / ¨ New Zealand Citizen / ¨ Australian Permanent Resident / ¨Visa Visa type: End date:
Country of origin:
Prior Qualifications / Education:
What is your highest completed school level? / Level completed: / Year completed:
Prior qualifications ( Certificate III level or above): ¨ Yes ¨ No If yes please list qualification(s): / State:
Year qualification(s) completed: ¨ Prior to 2005 ¨ Between 2005 and 2012 ¨ Date if known (Month/Year):
Language:
Language(s) other than English: ¨Yes ¨No If yes please language(s): / Is English assistance required: ¨Yes ¨No
Disabilities:
Do you consider yourself to have a disability, impairment or long term condition that requires consideration? ¨Yes ¨No
¨ Hearing / ¨ Intellectual / ¨ Mental illness / ¨ Medical condition / ¨ Physical / ¨ Learning / ¨ Vision / Other:
Would you like to receive advice on support services, equipment and facilities which may assist? ¨Yes ¨No
SCA meet the education requirements as specified according to the AQTF, any other requirements for licensing or registration need to be checked with the relevant regulatory authorities, example: Office of Fair Trading.
Qualification name: / Code:
Signature of Applicant: / Date:
Identification must accompany this form. (Copy of Drivers Licence or Birth Certificate)
Return to email: Fax: (07) 3832 4680 or post to PO Box 1280 Spring Hill Qld 4004.
Any queries please call (07) 3839 3011. Forms returned without identification cannot be processed.
SCA Student Application Form Dec 2011 v1.0 Page 1 of 1