4. Enrolment Form
Please fill in your details below to begin the enrolment process.
COURSE NAME
CLASS NAME
Contact Details
Your preferred title*
Full name*
Middle Name*
Last Name*
Organisation
POSITION
Birthday*
Email*
PHONE
Mobile
Fax
Home
Study Reason:
Address Information
Primary Residential Address*
BUILDING NAME
UNIT DETAILS
STREET NUMBER
STREET ADDRESS
PO BOX
CITY / SUBURB
STATE
POSTCODE
country
Primary Postal Address*
BUILDING NAME
UNIT DETAILS
STREET NUMBER
STREET ADDRESS
PO BOX
CITY / SUBURB
STATE
POSTCODE
country
Personal Details
Gender*
COUNTRY OF BIRTH
CITY OF BIRTH
COUNTRY OF CITIZENSHIP
Australian Citizenship Status:
Aboriginal or Torres strait Islander*
Employment Status:
Occupation Identifier (ANZSCO):
Industry of Employment (ANZSIC):
PRIMARY LANGUAGE SPOKEN
Proficiency in Spoken English:
English Assistance*
Attending other School, College or University?
Highest Completed School Level:
YEAR COMPLETED
Disabilities:
If Yes, Please Select:
Prior Education achieved:
If Yes, please select all that apply:

Please send any supporting documents that provide proof of your prior education to admin@pgdentalschool.edu.au

Unique Student Identifier
PLEASE ENTER YOUR UNIQUE STUDENT IDENTIFIER USI

Information

From January 2015 it is compulsory for all students enrolling in nationally recognised training at any College or University to obtain a Unique Student Identifier (USI). This number will be your own personal student number which can be used across all educational institutions.

If you do not already have a USI, you will need to create one prior to enrolment at the Postgraduate School of Dentistry. Please create a USI by clicking on the link below where you will be directed to the USI government website, then return here to continue your enrolment.

Create a usi

Please contact The Postgraduate School of Dentistry on +61 2 9362 5620 if you need any assistance in creating your USI.

Emergency Contact Information
CONTACT NAME *
RELATIONSHIP *
CONTACT PHONE NUMBER *
Payment due now to secure your place

FULL COURSE FEE: $XXX

AMOUNT DUE NOW: $3,000

If you are enroling as an international student please select PAYMENT FOR INTERNATIONAL STUDENTS

CARD NUMBER
CARD NUMBER
CARD NUMBER
CARD NUMBER
CARDHOLDER NAME
EXPIRATION Month
Expiration Year
CARD SECURITY CODE

Payment is required as follows:

Initial deposit of $3,000 required to secure your place;
Followed by monthly instalments of $1,000, beginning one month after you begin studying your first unit
If you wish to study by the unit, please enrol online and email admin@pgdentalschool.edu.au with details of the unit(s) you wish to enrol into.

Student Declaration

I understand that information contained in this form may be provided to State and Commonwealth agencies and research organisations and I consent to that occurring. 
I certify that all details provided on this form are correct.
I have accessed and understood information about the course in which I am enrolling at pgdentalschool.edu.au.
I have accessed the Student Handbook at pgdentalschool.edu.au and acknowledge that I have read and understood its content, including my rights and obligations.
I have accessed information about the fees applicable to this course at pgdentalschool.edu.au and understand my payment obligations.