GRADUATE CERTIFICATE IN
CATHOLIC STUDIES
APPLICATION FORM - VICTORIA
DCS
This application form is to be used by applicants for Graduate Certificate in Catholic Studies available at Australian Catholic University - Victoria.
CLOSING DATE :
28-June-2010
RETURN completed form to:
Admissions Section: PO Box 456, Virginia, QLD 4014
1
PREVIOUS ENROLMENT
Have you previously applied to study, or enrolled at ACU or one of its predecessor colleges?
No
(If no, go to Q2)
2
Yes
Surname on past record
Student ID (if known)
PERSONAL DETAILS
If academic records are submitted in another name please provide certified
evidence of change of name
Family Name
C Number
Given Names
C
Previous
Given/Other/Family Names
Date of Birth
Day
Permanent Home
Address
Month
Gender
Year
Male
Female
No and Street
Suburb/Town
State
Postcode
Country
Postcode
Country
Mailing Address
No and Street
Suburb/Town
State
(
Telephone
After Hours
Victorian Institute of Teaching Registration
Number (Please attach a copy of your card)
)
Mobile
EMPLOYMENT HISTORY
3
Are you currently employed in a Catholic School?
No
Yes
If yes, advise if Part-time or Full-time Please attach a letter of confirmation from your current Principal.
If yes, how long have you been employed in a Catholic school?
Years
If yes, will you be teaching Religious Education in 2009?
Yes
Yes
Are you being sponsored for this study?
Are you paying for this study yourself?
No
Yes
School Name:
No
No
If yes, please attach a letter of confirmation from your current Principal.
School E Number
E
School
Postcode:
School Postal Address:
School Telephone Number:
School Fax Number:
DISABILITY NOTIFICATION
5
Your responses to the following questions are needed to plan provision of education adjustments for students who may require them. Students who have a medical condition, long
term illness or a disability that may affect their studies are warmly encouraged to respond.
Information you provide to the University concerning the nature of your disability will be treated as confidential and will only be disclosed to relevant ACU staff to the extent necessary
to enable delivery of any education adjustments you may need, or where required by law. Refer to ACU’s Privacy Policy (http://www.acu.edu.au/145293).
Refer to http://www.acu.edu.au/10320 for information on how disability services are provided at ACU. ACU has a wide range of associated services that may be helpful to you, now
or in the future.
Do you have a medical condition, long term illness or a disability, which may affect your studies?
If yes, please check the box/es that best describe/s your disability or medical condition:
Hearing
Vision
Learning
Medical
Mobility
Would you like to receive advice on services, equipment and facilities which may assist you?
No
YES
Other
Yes
No
6
PERSONAL STATISTICAL DETAILS
• Are you of Aboriginal or Torres Strait Islander origin?
2
No
Yes, Aboriginal
3
Yes, Torres Strait Islander
4
5
Yes, Aboriginal & Torres Strait Islander
• Tick one box to indicate your citizenship and residence status.
Australian Citizen (1)
Yes
No
New Zealand Citizen (2)
Yes
No
Permanent Humanitarian Visa (8)
Yes
No
Possess a permanent resident visa (permitted to stay in Australia indefinitely, (3)
excluding New Zealand citizens and Humanitarian visas)
Yes
No
Yes
No
Yes
No
Date permanent resident status granted
Possess a temporary entry visa, student visa or visitor visa (4)
(including diplomats and their families)
Not in one of the above categories and reside outside Australia (5)
• Tick one box to indicate your country of birth.
Born in Australia
Not born in Australia Æ enter code from the Country codes list (see last page of this form)
(1100)
If country not listed, please advise:
Year arrived:
• Do you speak a language other than English at your permanent home address?
No (0001)
Yes,
Æ enter code from the Language other than English codes list (see last page of this form)
• Please indicate the highest level of study attained by each of your parents/guardians by selecting a letter (e.g. ‘D’ = Male completed Year 12 schooling or equivalent) from the
options below : (this information is required for Commonwealth Government reporting – please see www.deewr.gov.au )
Highest level of Attainment
Parent 1
A Male Postgraduate qualification
(e.g. Postgraduate Diploma, Masters, PhD)
B Male Bachelor Degree
C Male other post school qualification
(e.g. VET/TAFE Certificate, Associate Degree or Diploma)
D Male completed Year 12 schooling or equivalent
E Male did not complete Year 12 schooling or equivalent
F Male completed Year 10 schooling or equivalent
7
Please note: BOTH of these
boxes must be completed
Highest level of Attainment
Parent 2
G Male did not complete Year 10 schooling or equivalent
H Male Unknown
I Female Postgraduate qualification
(e.g. Postgraduate Diploma, Masters, PhD)
J Female Bachelor Degree
K Female other post school qualification
(e.g. VET/TAFE Certificate, Associate Degree or Diploma)
L
M
N
O
P
Q
R
Female completed Year 12 schooling or equivalent
Female did not complete Year 12 schooling or equivalent
Female completed Year 10 schooling or equivalent
Female did not complete Year 10 schooling or equivalent
Female Unknown
Not applicable (Male/Female)
No information provided
HIGH SCHOOL INFORMATION – ALL APPLICANTS (including applicants for postgraduate courses)
All applicants MUST complete this section.
This information is required by ACU for Government reporting purposes and to obtain an applicant’s Commonwealth Higher Education Student Support Number (CHESSN).
Name of High School attended
High school student number (if known)
Did you complete Year 12?
8
No
Postcode of high school attended
Yes
Æ
Postcode of permanent home
address whilst attending Year 12
Year of completion
TERTIARY HISTORY (Record all studies including any at ACU)
Provide an official certified transcript for all tertiary studies undertaken excluding ACU studies. Your application will not be processed further if documentation is not correctly
certified. NB: New documentation must be submitted with every application as previous applications are not retained.
Years Undertaken
From / To
Name of Course, e.g. B.Arts
Name of Institution, e.g. University
/
/
/
Have you ever been excluded from a tertiary course
and/or institution? No
Yes
Æ
If yes, provide details including
effective dates
Completed
Yes/No/Current
APPLICANT CHECKLIST
9
I have completed all sections of the application form.
I have attached original suitably certified documentary evidence, including proof of completion of my previous qualification/s, as required, in support of my application.
I am aware that without correct certification my application will not be processed.
I have attached an Application for Credit and supporting documentation.
I have attached a copy of my current VIT registration.
I have attached a letter of confirmation from my current Principal.
I have read ACU’s request for informed consent, privacy statement, the declaration, and signed the application.
10
PRIVACY / INFORMED CONSENT / DECLARATION
ACU is committed to ensuring the privacy of all information it collects. Personal information collected by the University will only be used for administrative and educational purposes, including,
but not limited to, statistical information, in a form that does not identify anyone, to assist us in the marketing and planning of the institution. Personal information collected by the University will
only be disclosed to third parties with the written consent of the person concerned, unless otherwise stated by law. I have read the University’s statement on privacy and the purposes for which
my personal iniformation will be used (see the University’s Statement on Privacy, and the Student Administration Privacy Policy located at http://www.acu.edu.au/145293
I understand that: -
ACU is collecting the information in this form for the purpose of assessing my eligibility for a place and my entitlement under the Higher Education Support
Act 2003, and where relevant the allocation to me of a Commonwealth Higher Education Student Support Number (CHESSN);
ACU will disclose this information to the Department of Education, Science and Training (DEST) for those purposes;
DEST will store the information securely in the Higher Education Information Management System;
DEST may disclose the information to the Australian Taxation Office (ATO); and
ACU will not otherwise disclose the information without my consent unless required or authorised by law.
If personal information is not provided when requested, it may not be possible for the University to process your application.
I agree to abide by University statutes, regulations, standards of conduct, policies and procedures. I acknowledge that the information supplied herein is correct and complete. I acknowledge
that the submission of incorrect or incomplete information may result in a cancellation of enrolment at any stage. I recognise that it is my responsibility to provide all necessary documentary
evidence of my qualifications. I authorise the University to obtain further information with respect to my application and, if necessary, provide information to educational institutions, admission
centres and QualSearch. I understand that if my academic record is not obtained by QualSearch, a certified copy will be required by ACU. I understand that the results of a QualSearch will be
made available to me on request and that an audit of this authority may also be undertaken.
Applicant’s Signature
Australian Catholic University Limited
Date
ABN: 15 050 192 660
/
CRICOS Provider registration codes: 0004G, 00112C, 00873F, 00885B
/
DCS
INFORMATION FOR APPLICANTS
CERTIFICATION OF DOCUMENTS
If you are lodging an application for admission to any award course at ACU, you MUST provide CERTIFIED COPIES of any previous qualification/s and/or any other supporting
documentation in relation to your application. Examples of such documents include:
•
Academic qualifications including testamurs/academic transcripts/result certificates
•
Birth/marriage certificates etc. required as evidence of name change
•
Copy of Permanent Resident Visa
•
Copy of Australian Certificate of Citizenship
AN ACADEMIC TRANSCRIPT DOWNLOADED FROM A WEBSITE IS NOT ACCEPTABLE, AS IT IS NOT AN OFFICIAL ACADEMIC RECORD. ANY DOCUMENTATION
NOT PROPERLY CERTIFIED WILL BE RETURNED AND YOUR APPLICATION WILL NOT BE ASSESSED.
Refer to website http://www.acu.edu.au/154909 for suitably qualified people who can certify a document. It is not necessary to provide academic transcripts for any studies
undertaken at ACU.
COUNTRY CODES
AD ADELIE LAND (FRANCE)
AF AFGHANISTAN
AL ALBANIA
AG ALGERIA
AO ANDORRA
AN ANGOLA
AH ANGUILLA
AT ANTARCTICA NFD
AB ANTIGUA AND BARBUDA
AR ARGENTINA
AC ARGENTINIAN ANTARCTIC TERRITORY
AM ARMENIA
AA ARUBA
AU AUSTRALIA
AS AUSTRALIAN ANTARCTIC TERRITORY
AI AUSTRIA
AZ AZERBAIJAN
BA BAHAMAS
BH BAHRAIN
BD BANGLADESH
BB BARBADOS
BL BELARUS
BE BELGIUM
BI BELIZE
BN BENIN
BM BERMUDA
BP BHUTAN
BO BOLIVIA
BG BOSNIA AND HERZEGOVINA
BS BOTSWANA
BR BRAZIL
BT BRITISH ANTARCTIC TERRITORY
BC BRUNEI DARUSSALAM
BU BULGARIA
BF BURKINA FASO
BY BURMA (MYANMAR)
BW BURUNDI
CB CAMBODIA
CM CAMEROON
CA CANADA
CV CAPE VERDE
CE CARIBBEAN NFD
CI CAYMAN ISLANDS
CP CENTRAL AFRICAN REPUBLIC
CF CENTRAL AMERICA NFD
CW CENTRAL AND WEST AFRICA NFD
CD CENTRAL ASIA NFD
CH CHAD
CC CHANNEL ISLANDS
CL CHILE
CJ CHILEAN ANTARCTIC TERRITORY
CN CHINA (EXCLUDES SARS AND TAI
CS CHINESE ASIA (INCLUDES MONGO
CO COLOMBIA
AE COMOROS
CG CONGO
CX CONGO, DEMOCRATIC REPUBLIC OF
CK COOK ISLANDS
CR COSTA RICA
CQ COTE D'IVOIRE
CT CROATIA
CU CUBA
CY CYPRUS
CZ CZECH REPUBLIC
DK DENMARK
DJ DJIBOUTI
DM DOMINICA
DO DOMINICAN REPUBLIC
EA EAST TIMOR
EE EASTERN EUROPE NFD
EC ECUADOR
EG EGYPT
EL EL SALVADOR
EN ENGLAND
EQ EQUATORIAL GUINEA
ER ERITREA
ES ESTONIA
ET ETHIOPIA
FA FAEROE ISLANDS
FL FALKLAND ISLANDS
FJ FIJI
FI FINLAND
FY FORMER YUGOSLAV REPUBLIC OF
MACEDONIA (FYROM)
FR FRANCE
FG FRENCH GUIANA
FP FRENCH POLYNESIA
FU Former YUGOSLAVIA
GA GABON
GM GAMBIA
GZ GAZA STRIP AND WEST BANK
GE GEORGIA
GY GERMANY
GH GHANA
GI GIBRALTAR
GR GREECE
GN GREENLAND
GD GRENADA
GP GUADELOUPE
GU GUAM
GL GUATEMALA
GC GUINEA
GB GUINEA-BISSAU
GF GUYANA
HT HAITI
HS HOLY SEE
HN HONDURAS
HK HONG KONG (SAR OF CHINA)
HU HUNGARY
IC ICELAND
IN INDIA
ID INDONESIA
IR IRAN
IQ IRAQ
IE IRELAND
IM ISLE OF MAN
IL ISRAEL
IT ITALY
JA JAMAICA
JP JAPAN
JK JAPAN AND THE KOREAS NFD
JO JORDAN
KA KAZAKHSTAN
KE KENYA
KI KIRIBATI
KD KOREA, DEMOCRATIC PEOPLE'S
REPUBLIC OF (NORTH)
KO KOREA REPUBLIC OF (SOUTH)
KW KUWAIT
KY KYRGYZ REPUBLIC
LA LAOS
LV LATVIA
LB LEBANON
LS LESOTHO
LR LIBERIA
LI LIBYA
LC LIECHTENSTEIN
LH LITHUANIA
LU LUXEMBOURG
MA MACAU
MD MADAGASCAR
MN MAINLAND SOUTH-EAST ASIA NF
MW MALAWI
MY MALAYSIA
MS MALDIVES
MI MALI
ML MALTA
MH MARSHALL ISLANDS
MQ MARTINIQUE
MU MAURITANIA
MK MAURITIUS
MO MAYOTTE
ME MELANESIA NFD
MX MEXICO
MF MICRONESIA FEDERATED STATES
MM MICRONESIA NFD
MB MIDDLE EAST NFD
MV MOLDOVA
MC MONACO
MG MONGOLIA
MT MONTSERRAT
MR MOROCCO
MZ MOZAMBIQUE
NA NAMIBIA
NR NAURU
NP NEPAL
NL NETHERLANDS
NE NETHERLANDS ANTILLES
NC NEW CALEDONIA
NZ NEW ZEALAND
NK NICARAGUA
NI NIGER
NG NIGERIA
NU NIUE
NH NORTH AFRICA NEC
LANGUAGE OTHER THAN ENGLISH CODES
NN
ND
NT
NM
NO
OM
PK
PU
PA
PN
PG
PE
PH
PL
PO
PT
PR
QA
QU
RE
RO
RU
RW
SM
SO
SN
ST
SA
SC
SE
SR
SY
SL
SG
SV
SZ
SI
SP
SF
SX
BJ
AV
AX
AW
SB
SK
SH
BK
BV
SQ
SJ
SU
BX
SD
SS
SW
SY
TA
TJ
TN
TH
TG
TK
TO
TI
TU
TR
TM
TC
TV
UG
UR
UA
UK
US
UY
UZ
VA
VE
VN
VI
VS
WA
WL
WE
WS
YE
ZA
ZI
NORTHERN AMERICA NFD
NORTHERN EUROPE NFD
NORTHERN IRELAND
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
POLAND
POLYNESIA (EXCLUDES HAWAII)
PORTUGAL
PUERTO RICO
QATAR
QUEEN MAUD LAND (NORWAY)
REUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAMOA
SAMOA AMERICAN
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SCOTLAND
SENEGAL
SERBIA & MONTENEGRO
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAK REPUBLIC
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH AMERICA NEC
SOUTH EASTERN EUROPE NFD
SOUTHERN AND EAST AFRICA NEC
SOUTHERN ASIA NFD
SOUTHERN EUROPE NFD
SPAIN
SRI LANKA
ST HELENA
ST KITTS AND NEVIS
ST LUCIA
ST PIERRE AND MIQUELON
ST VINCENT AND THE GRENADINES
SUDAN
SURINAME
SWAZILAND
SWEDEN
SWITZERLAND
SYRIA
TAIWAN
TAJIKISTAN
TANZANIA
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM NFD
UNITED STATES OF AMERICA
URUGUAY
UZBEKISTAN
VANUATU
VENEZUELA
VIET NAM
VIRGIN ISLANDS BRITISH
VIRGIN ISLANDS UNITED STATES
WALES
WALLIS AND FUTUNA
WESTERN EUROPE NFD
WESTERN SAHARA
YEMEN
ZAMBIA
ZIMBABWE
Code
AA
AB
AC
AE
AF
AG
AK
AL
AM
AN
AO
AR
AS
AU
AY
BA
BE
BI
BL
BN
BO
BQ
BR
BU
CA
CE
CH
CL
CN
CR
CS
CT
CY
DA
DE
DR
DU
EA
EL
EN
ES
ET
FH
FI
FL
FN
FR
FY
GA
GE
GI
GU
HA
HE
HG
HI
HM
HO
HU
IB
IC
ID
II
IN
IR
IS
IT
IV
JA
KA
KD
KH
KI
KN
KO
KR
LA
LB
LE
LO
Description
African Languages, nec
Arabic (including Lebanese)
Acholi
Armenian
Afrikaans
Afghani
Akan
Albanian
Amharic
Auslan
Aromunian (Macedo-Romanian)
American Languages
Asante
Australian Indigenous Language
Assyrian (including Aramaic)
Baltic, nfd
Belorussian
Bisaya
Bulgarian
Bengali
Bosnian
Basque
Burmese and Related languages, nec
Burmese
Catalan
Cebuano
Chinese, nec
Celtic, nec
Mandarin
Croatian
Czech
Cantonese
Welsh
Danish
German
Dravidian, nec
Dutch
East Slavic, nfd
Greek
English
Spanish
Estonian
Finnish
Fijian
Flemish
Finnish and Related Languages, nec
French
Frisian
Gaelic (Scotland)
German
Gilbertese
Gujarati
Hakka
Hebrew
Hmong-Mien, nec (Mien, Yao)
Hindi
Hmong
Hokkien
Hungarian
Iberian Romance, nec
Icelandic
Indonesian
Ilokano
Indo-Aryan, nec
Iranic, nec
Irish
Italian
Invented Languages
Japanese
Kazakh
Kurdish
Khmer
Krio
Kannada
Konkani
Korean
Latin
Lebanese
Letzeburgish
Lao
LT
LU
LV
MA
MC
MD
MI
MK
ML
MM
MN
MO
MR
MT
MY
NA
NE
NF
NI
NO
NT
OA
OC
OE
OI
OL
ON
OP
OR
OS
OT
OY
PA
PE
PG
PI
PK
PN
PO
PP
PT
PU
RM
RO
RU
SB
SC
SD
SE
SH
SI
SK
SL
SM
SN
SO
SR
SS
SW
SY
TA
TB
TC
TE
TG
TH
TI
TM
TN
TO
TP
TR
TT
TX
TZ
UK
UR
UZ
VI
WE
WS
WU
YI
YO
ZU
Lithuanian
Luganda
Latvian
Makaton
Mauritian Creole
Middle Eastern Semitic Languages, nec
Maori (New Zealand)
Macedonian
Malayalam
Motu
Mon-Khmer, nec
Maori (Cook Island)
Marathi
Maltese
Malay
Nauruan
Nepali
Non-English (no info. on lang)
Niue
Norwegian
Dutch
Other Southeast Asian Language
Oceanic Austronesian Languages
Other Eastern Asian Languages
Languages of India Other
Other Eastern European Languages, nec
Other Non-English Languages
Oceanian Pidgins and Creoles, nec
Oromo
Other Southern Asian Languages
Other Southern European Languages, nec
Yugoslavian Language Other
Pashto
Persian
Pidgin
Pilipino
Pakistani Languages Other
Papuan Languages
Polish
Papuan Languages
Portuguese
Punjabi
Romany
Romanian
Russian
Serbo-Croatian
Scandinavian, nec (Faeroese)
Sindhi
Serbian
Sinhalese
Sign Languages, nec
Slovak
Slovene
Samoan
Shona
Somali
Sri Lankan Languages Other
South Slavic, nfd
Swahili
Swedish
Tamil
Tartar
Turkic, nec
Telugu
Tagalog (Filipino)
Thai
Tigrinya
Timorese
Tongan
Teochew
Tok Pisin
Turkish
Tetum
Tibetan
Tai, nec
Ukrainian
Urdu
Uzbek
Vietnamese
Pacific Austronesian Languages, nec
West Slavic, nfd
Wu
Yiddish
Yoruba
Zulu