ENROLMENT SUCCESS RPL - Postgraduate School of Dentistry

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FIRST NAME *

SURNAME *

COUNTRY OF BIRTH *

CITY OF BIRTH *

COUNTRY OF CITIZENSHIP *

AUSTRALIAN CITIZENSHIP STATUS: *

Aboriginal or Torres strait Islander *

Aboriginal

Torres Strait Islander

STUDY REASON:

2. Emergency Contact Information

CONTACT NAME *

RELATIONSHIP *

CONTACT PHONE NUMBER *

3. Employment Status

Employment Status: *

Occupation Identifier (ANZSCO): *

Industry of Employment (ANZSIC): *

PRIMARY LANGUAGE SPOKEN *

PROFICIENCY IN SPOKEN ENGLISH: *

English Assistance *

YES

4. Academic Status

Attending other School, College or University? *

YES

Highest Completed School Level: *

YEAR COMPLETED *

Prior Education achieved: *

Yes

Not Specified

If Yes, please select all that apply:

Bachelor Degree or Higher Degree Level

Advanced Diploma or Associate Degree Level

Diploma Level

Certificate IV

Certificate III

Certificate II

Certificate I

Miscellaneous Education

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

5. Unique Student Identifier

Unique Student Identifier *

PLEASE ENTER YOUR UNIQUE STUDENT IDENTIFIER USI

Information

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.

6. Disability

Disabilities: *

Yes

Not Specified

Do you believe you require learning support to successfully participate in training? If unsure, we will contact you to discuss and identify the learning support or adaptive technology you need. *

YES

Unsure

If yes, please describe any learning support or assistive technology you believe you require to successfully participate in the course in which you are enrolling.

7. Upload your photo ID

Your photo will be retained on file and may be used to authenticate assessment evidence. For example, if assessments require you to submit photos or video of you carrying out certain tasks or procedures, your assessor will compare your photo to the person appearing in the photos or videos to confirm the evidence presented for assessment is your own work. This is the only reason for requesting you to provide a photo of yourself

Student Declaration and Consent

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.

YES

1. Additional Information – RPL