Student Information Form

Personal details

Enter your full name*

* Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI and want The Institute of Applied Psychology to apply for a USI on your behalf, you must write your name, including any middle names, exactly as written in the identity document you choose to use for this purpose. See section on the USI at the end of this form for a detailed explanation.

Provide your full name & title as you wish it to appear on your Certificate

Enter your birth date

Gender

Male
Female
Other

Phone (H):*

Phone (W):*

Mobile:*

Email*

Alternative email address (optional)

What is the address of your usual residence?

Please provide the physical address (street number and name not post-office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home. If you are from a rural area use the address from your state or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address. Building/property name is the official place name or common usage name for an address site, including the name of a building, Aboriginal community, homestead, building complex, agricultural property, park or unbounded address site.

Building/property name

Flat/unit details

Street or lot number (e.g. 205 or Lot 118)

Street name

Suburb:*

State:*

Postcode:*

What is your postal address (if different from above)?

Language and cultural diversity

In which country were you born?

Do you speak a language other than English at home:*

Are you of Aboriginal or Torres Strait Islander Origin:*

Do you consider yourself to have a disability, impairment or long-term condition*

Disability

Do you consider yourself to have a disability, impairment or long-term condition?

Yes
No

If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:

Hearing/deaf
Physical
Intellectual
Learning
Mental illness*
Acquired brain impairment
Vision
Medical condition
Other

(You may indicate more than one area) Please refer to the Disability supplement for an explanation of the following disabilities. *If you have ever been diagnosed with a mental health condition (previous or current), you must alert The Institute ofApplied Psychology at the point of enrolment.

Schooling

What is your highest COMPLETED school level? (Tick ONE box only)

Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent
Year 9 or equivalent
Year 8 or below
Never attended school

If you are currently enrolled in secondary education, the Highest school level completed refers to the highest school level you have actually completed and not the level you are currently undertaking. For example, if you are currently in Year 10 the Highest school level completed is Year 9.

Are you still enrolled in secondary or senior secondary education?

Previous qualifications achieved

Have you SUCCESSFULLY completed any of the qualifications listed in next question?

Yes
No

If YES, tick ANY applicable boxes.

Select All
Bachelor degree or higher degree
Advanced diploma or associate degree
Diploma (or associate diploma)
Certificate IV (or advanced certificate/technician)
Certificate III (or trade certificate)
Certificate II
Certificate I
Other education (including certificates or overseas qualifications not listed above)

Employment

Of the following categories, which BEST describes your current employment status? (Tick ONE box only)

Full-time employee
Part-time employee
Self employed – not employing others
Self employed – employing others
Employed – unpaid worker in a family business
Unemployed – seeking full-time work
Unemployed – seeking part-time work
Not employed – not seeking employment

For casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full time (35 hours or more per week) or part-time employed (less than 35 hours per week).

Study reason

Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/apprenticeship (Tick ONE box only)

Unique Student Identifier (USI)

From 1 January 2015, we The Institute of Applied Psychology are precluded from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI you can apply for it directly at http://www.usi.gov.au/create-your-USI/ on computer or mobile device. Please note that if you would like to specify your gender as ‘other’ you will need to contact the USI Office for assistance.

Enter your Unique Student Identifier (USI) (if you already have one)

Unique student identifier USI application through your RTO (if you do not already have one) If you are having additional issues with obtaining a USI via the government website, mobile device and have called the USI Office for support, please contact our office on 1300 380 681 for further assistance.