Application form
Australian students Please print in BLOCK LETTERS
Personal details Title:
Mr
Ms
Program selection Mrs
Miss
Other
Family name: Given names: Preferred name: Date of birth: DAY / MONTH / YEAR
Gender:
Male
Female
Diploma of Arts Diploma of Health Science Diploma of Business Diploma of Information Technology Diploma of Engineering SAIBT program commencement Please indicate the year and trimester in which you wish to begin your studies. February June October Year:
University of South Australia program
Contact details Applicant’s contact details
Bachelor preference:
Address:
Other information
Postcode: Tel (home):
How did you first learn about SAIBT? You may tick more than one.
Tel (work):
UniSA Letter from UniSA SAIBT advertising School careers counsellor Recommended by a friend/relative If ‘yes’, to SAIBT advertising, please specify (E.g. online, radio, TV, print):
Mobile: Email: Country of birth:
Application checklist
Nationality: Are you currently onshore in Australia?
Yes
Check that you have:
No
Are you a citizen or permanent resident of Australia? Yes No Please note that you will have to provide evidence of citizenship or residency at or before enrolment (eg a certified copy of your birth certificate, passport, citizenship certificate or visa).
Education details Secondary Education—highest level achieved Name of qualification (eg SACE Stage 2, other Year 12):
Declaration
School attended:
I declare the information I have supplied on this form is, to the best of my understanding and belief, complete and correct. I understand that giving false or incomplete information may lead to my application being refused or my enrolment cancelled. I have read and understood the relevant program information in this brochure and/or on the SAIBT website and I have sufficient information about SAIBT to enrol. I understand that the pathway may lead to future studies at the University of South Australia, subject to the University of South Australia’s entry requirements. I give permission for SAIBT and the University of South Australia to obtain official records from an educational institution attended by me, and to supply my contact details and any relevant official records to educational institutions I am eligible to gain admission to. I understand that the fees quoted may be subject to increase. I understand that any conditions concerning an offer of admission will be contained in my letter of offer from SAIBT, which I will be required to read and sign.
Yes
No
Year completed:
Tertiary and further education—highest level achieved Name of qualification (eg degree, diploma, STAT test): Institution attended: Country/state: Completed:
Yes
No
Year completed:
Please attached certified copies of all academic transcripts or mark sheets. Will you be applying for exemptions (recognition of prior learning)? Yes No If ‘yes’, provide copies of relevant academic transcripts and a completed Application for Credit form (visit saibt.sa.edu.au for details).
Employment history If you believe you have employment experience relevant to the program you are applying for, please attach a CV and references.
Request for disability support Do you have a disability that may affect your studies?
Applicant signature:
Date:
If you are under 18 years of age, your parent or guardian must also sign this application form.
Parent/guardian signature:
Date: Yes
No
If ‘yes’, please specify: Hearing Vision Mobility Medical Learning Other (please specify): Please attach relevant information so that SAIBT and the University of South Australia can arrange assistance if possible. CRICOS provider codes: SAIBT 02193C; University of South Australia 00121B
DAY / MONTH / YEAR
DAY / MONTH / YEAR
Postal address for applications Admissions Office South Australian Institute of Business and Technology GPO Box 2471 Adelaide SA 5001 Australia T +61 8 8302 2021 E
[email protected]
F +61 8 8302 1557 W saibt.sa.edu.au
SAIBT1152_0115_AW
Country/state: Completed:
completed all sections of the Application form attached certified copies of your academic qualifications* included relevant employment documentation (if required) included a copy of your birth certificate or passport * A certified copy is signed by an authorised officer to acknowledge that it matches the original document exactly. Authorised officers include: • staff of the SAIBT office in Adelaide • staff of the institution that issued the document • a Justice of the Peace or Public Notary • staff of an Australian Embassy, Consulate or High Commission