GOVERNMENT STATISTICS
Please note that this form should be lodged at the Student Centre in person.
Email: [email protected]
Fax: 02 62015040 Student Centre: 1B150
Student ID No.
Family name or Surname
Contact Telephone Number
Given Name(s)
All electronic communication from the University will be sent to your student email
u
@uni.canberra.edu.au
I declare that the information I have supplied on this form is complete and correct to the best of my knowledge.
Student’s Signature
Date
Q1: Are you of Aboriginal or Torres Strait Islander descent?
□ Neither Aboriginal nor Torres Strait Islander origin
□ Of Aboriginal and Torres Strait Islander origin
□ Of Aboriginal origin
□ Of Torres Strait Islander origin
Q2: What is your current citizenship status?
□ Australian citizen (including Australian citizens with dual citizenship)
□ Humanitarian visa holder
□ New Zealand citizen or a diplomat or consular representative of New Zealnad, a member of the staff of such a
representative or the spouse or dependant relative of such a representative, excluding those with Australian
citizenship. (Note: include any such persons with Permanent Residence status)
□ Student has a temporary entry permit or is a diplomat or a dependant of a diplomat (except New Zealand) and
resides in Australia during this semester. International student visa holder.
□ Student with Permanent Residence status but excluding those who have New Zealand citizenship.
□ Citizenship other than above.
Q3: Not used
Q4: In what country is your permanent home address?
Australian postcode:
OR
Overseas country:
Q5: In what country is your permanent residence during the year?
Australian postcode:
OR
Overseas country:
Australia Government Higher Education Provider Number 00212K
Personal information collected by the University is subject to the Commonwealth Privacy Act 1988
Postal Address: Student Centre, University of Canberra , Bruce, ACT Australia 2601
Phone 1300 301 727 Fax: +61 (0)2 6201 5040 Email: [email protected]
Q6: In what country were you born? When did you arrive in Australia?
□ Born in Australia
OR
□ Overseas country:
Year of arrival in Australia:
Q7: What language do you speak at home?
□ English
OR
□ Other language:
Q8: What was your postcode during Year 12?
Postcode:
Suburb/Town:
Q9: What education did you complete before this course?
a) Post-graduate course of any type:
□ Never commenced
□ Commenced such a course, but not all requirements completed
□ Completed all requirements
Last year of enrolment:
b) Bachelor’s degree course:
□ Never commenced
□ Commenced such a course, but not all requirements completed
□ Completed all requirements
Last year of enrolment:
c) University or College Diploma or Associate Diploma:
□ Never commenced
□ Commenced such a course, but not all requirements completed
□ Completed all requirements
Last year of enrolment:
d) TAFE Diploma or Associate Diploma:
□ Never commenced
□ Commenced such a course, but not all requirements completed
□ Completed all requirements
Last year of enrolment:
e) Other TAFE course:
□ Never commenced
□ Commenced such a course, but not all requirements completed
□ Completed all requirements
Last year of enrolment:
f) Final year of secondary education at school or college:
□ Did not do final year
□ Did final year
Last year of enrolment:
g) Final year of secondary education at another institution:
□ Did not do or complete such a course
□ Did final year and completed all of the requirements for the course
Last year of enrolment:
h) Other qualification or certificate:
□ Did not have other qualification
□ Did have some other qualification
Last year of enrolment:
Q10: Not used
Q11: Please specify if you have a disability
□ No, I do not have a disability
OR
□
□
□
□
□
Hearing impairment
Mobility impairment
Learning impairment
Other disability
□
□
Medical impairment
Psychiatric illness
Vision impairment
*If you ticked YES to any disability, would you like to be contacted by UCaccessibility
□ Yes
□ No
Q12: What is the highest level of participation in education you undertook prior to this course?
□ A complete higher education postgraduate course
□ A complete higher education bachelor’s degree course
□ A complete higher education sub-degree course
□ An incomplete higher education course
□ A complete final year of secondary education course (at school or TAFE)
□ A complete other qualification or certificate of attainment or competence
□ No prior education attainment
□ A complete TAFE (VTE) award course
□ An incomplete TAFE (VTE) award course
Last year of enrolment
Q13: Have you completed your final year of secondary education?
□ Yes
□ No
Last year of enrolment:
Q14: What is your parent/guardian highest educational attainment?
Female parent/gaurdian
Male parent/gaurdian
□ Did not complete Year 10 or equivalent
□ Completed Year 10 or equivalent
□ Did not complete Year 12 or equivalent
□ Complete Year 12 or equivalent
□ VET Cert, Associate Degree or Diploma
□ Bachelor Degree
□ Postgraduate course, eg Masters, Grad Dip, PhD
□ Don’t know educational background
□ Did not complete Year 10 or equivalent
□ Completed Year 10 or equivalent
□ Did not complete Year 12 or equivalent
□ Complete Year 12 or equivalent
□ VET Cert, Associate Degree or Diploma
□ Bachelor Degree
□ Postgraduate course, eg Masters, Grad Dip, PhD
□ Don’t know educational background