This form contains 129 fields organized into 28 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name Type Description
ABSTUDY, Austudy, Youth Allowance, or Age Pension Payments Status
No Checkbox
Check this box if you are not currently receiving and do not intend to continue receiving any ABSTUDY, Austudy, Youth Allowance or Age Pension payments.
Yes Checkbox
Check this box if you are currently receiving or intend to continue receiving any ABSTUDY, Austudy, Youth Allowance or Age Pension payments.
Apprentice or Trainee Employment Status
No Checkbox
Check this box if you will not be employed as a full-time apprentice or trainee for the period of study you are claiming Pensioner Education Supplement.
Yes Checkbox
Check this box if you will be employed as a full-time apprentice or trainee for the period of study you are claiming Pensioner Education Supplement, as this means you are not eligible.
Bank Account Details
Bank Name Text
Please enter the full name of your bank, building society, or credit union. Fill only if 'Do you want your payment made into an account in which another payment from us is made (if applicable)?' is 'No'.
Depends on: No
Branch Number (BSB) Text
Please enter the Branch State Bank (BSB) number for your bank account. Fill only if 'Do you want your payment made into an account in which another payment from us is made (if applicable)?' is 'No'.
Max length: 6 characters
Depends on: No
Account Number Text
Please enter your bank account number, ensuring it is not your card number. Fill only if 'Do you want your payment made into an account in which another payment from us is made (if applicable)?' is 'No'.
Depends on: No
Account Holder Name(s) Text
Please enter the full name(s) of the individual(s) or entity in whose name the account is held. Fill only if 'Do you want your payment made into an account in which another payment from us is made (if applicable)?' is 'No'.
Depends on: No
Contact Details
Home Phone Number Text
Please enter your home phone number, including the area code.
Max length: 10 characters
Mobile Phone Number Text
Please enter your mobile phone number.
Max length: 10 characters
Alternative Phone Number Text
Please enter an alternative phone number, including the area code.
Max length: 10 characters
Email Address Text
Please enter your email address.
Course Details
Student Identification Number Text
Provide your student identification number issued by your education institution.
Exact Course Title Text
Enter the full and exact title of the course you are currently studying, including any specializations.
Course Code Text
Enter the official course code assigned to your program of study, if applicable.
Year/Stage of Course Text
Indicate the current year or stage you are at in your course, such as '1st year' or 'Year 11'.
Hours Per Week Formal Study Number
Enter the number of hours per week you attend formal coursework or lectures, excluding private study time.
Max length: 3 characters
Course Start Date Date
Enter the date when you started studying this course.
Max length: 10 characters
Course Completion Date Date
Enter the date when you expect to complete this course.
Max length: 10 characters
Customer Reference Number
Customer Reference Number - Part 1 Text
Enter the first part of your customer reference number.
Max length: 3 characters
Customer Reference Number - Part 2 Text
Enter the second part of your customer reference number.
Max length: 3 characters
Customer Reference Number - Part 3 Text
Enter the third part of your customer reference number.
Max length: 3 characters
Customer Reference Number - Part 4 Text
Enter the fourth part of your customer reference number.
Max length: 1 characters
Date of Birth
Date of Birth Date
Please enter your date of birth.
Max length: 10 characters
Declaration
Signature Text
Enter your full legal signature for this declaration.
Declaration Date Date
Provide the date on which this declaration is made.
Max length: 10 characters
Documents Provided Checklist
Identity Documents (Veterans' Affairs) Checkbox
Check this box if you are providing identity documents because you receive a payment from the Department of Veterans' Affairs. Fill only if 'Do you receive a pension from the Department of Veterans' Affairs?' is 'Yes'.
Depends on: Yes
Proof of Study Break (Circumstances beyond control) Checkbox
Check this box if you are providing a copy of proof of evidence for a study break due to circumstances beyond your control, and you answered 'Yes' at question 12 or question 16. Fill only if 'Have you attempted Year 12 before?' is 'Yes'.
Depends on: Yes
Proof of Enrolment Checkbox
Check this box if you are providing a copy of your proof of enrolment, as required at question 13.
List of Subjects Checkbox
Check this box if you are providing a list of subjects because you answered 'Not sure' at question 13. Fill only if 'Are you enrolled on a full-time or part-time basis?' is 'Not sure'.
Depends on: Not sure
Proof of Startup Year enrolment and STARTUP-HELP loan selection Checkbox
Check this box if you are providing a copy of evidence that you are enrolled in the Startup Year course and have been selected for a STARTUP-HELP loan, and you answered 'Yes' at question 14. Fill only if 'Are you studying a Startup Year course?' is 'Yes'.
Depends on: Yes
Education Institution Details
Institution Name Text
Provide the full name of the school, college, university, or campus where you are currently studying.
Address Line 1 Text
Enter the first line of the education institution's address.
Address Line 2 Text
Enter the second line of the education institution's address.
Address Line 3 Text
Enter the third line of the education institution's address, which may include suburb or city.
Postcode Text
Provide the postcode of the education institution's address.
Max length: 4 characters
Enrollment Basis
Full-time 75-100% Checkbox
Check this box if your enrollment is full-time, representing 75-100% of the full-time studyload.
Q13.Enrolled_PT CheckBox
Full-time Study Load Percentage Number
Please enter the percentage of your full-time study load. Fill only if 'Full-time 75-100%' is 'Yes'.
Depends on: Full-time 75-100%
Part-time 66-74% Checkbox
Check this box if your enrollment is part-time, representing 66-74% of the full-time studyload. Fill only if 'Q13.Enrolled_PT' is 'Yes'.
Depends on: Q13.Enrolled_PT
Part-time 50-65% Checkbox
Check this box if your enrollment is part-time, representing 50-65% of the full-time studyload. Fill only if 'Q13.Enrolled_PT' is 'Yes'.
Depends on: Q13.Enrolled_PT
Part-time 25-49% Checkbox
Check this box if your enrollment is part-time, representing 25-49% of the full-time studyload. Fill only if 'Q13.Enrolled_PT' is 'Yes'.
Depends on: Q13.Enrolled_PT
Part-time 0-24% Checkbox
Check this box if your enrollment is part-time, representing 0-24% of the full-time studyload. Fill only if 'Q13.Enrolled_PT' is 'Yes'.
Depends on: Q13.Enrolled_PT
Not sure Checkbox
Check this box if you are unsure of your enrollment basis and need to provide a list of your subjects.
External/Distance Education Status
No Checkbox
Check this box if you are not studying as an external student or by distance education.
Yes Checkbox
Check this box if you are studying as an external student or by distance education.
First Past Post Secondary Study
Years of Study Text
Please provide the years during which you undertook this study, for example, 2016-2018.
Full-time Checkbox
Check this box if your first past post-secondary study was full-time.
Part-time Checkbox
Check this box if your first past post-secondary study was part-time.
Institution Name Text
Please provide the name of the institution or campus where you undertook this study, for example, Melbourne University.
Course Name Text
Please provide the name of the course you undertook, for example, Bachelor of Arts.
No Checkbox
Check this box if you did not complete the first past post-secondary course.
Yes Checkbox
Check this box if you completed the first past post-secondary course.
Flexible Learning Course Enrollment
No, not enrolled in flexible learning course Checkbox
Check this box if you will not be enrolled in a flexible learning course.
Yes, enrolled in flexible learning course Checkbox
Check this box if you will be enrolled in a flexible learning course, such as an open learning or self-paced course.
Fourth Past Post Secondary Study
Fourth Study Years Text
Enter the years during which the fourth past post-secondary study took place, for example, 2016-2018.
Full-time Study Checkbox
Check this box if the fourth past post-secondary study was undertaken on a full-time basis.
Part-time Study Checkbox
Check this box if the fourth past post-secondary study was undertaken on a part-time basis.
Fourth Study Institution/Campus Name Text
Provide the name of the institution or campus where the fourth past post-secondary study was undertaken.
Fourth Study Course Name Text
Enter the full name of the course for the fourth past post-secondary study, for example, Bachelor of Arts.
Did Not Complete Course Checkbox
Check this box if you did not complete the fourth past post-secondary course.
Completed Course Checkbox
Check this box if you completed the fourth past post-secondary course.
Full Course Period
Official Start Date Date
Enter the official start date of the full course.
Max length: 10 characters
Official End Date Date
Enter the official end date of the full course.
Max length: 10 characters
General
Instructions Button
Instructions Button
Q6.Address1 Text
Q6.Address2 Text
Q7.Address1 Text
Q7.Address2 Text
Q9GoToQ11 Button
Q14GoToQ17 Button
Q15GoToQ17 Button
Print button Button
Clear button Button
Name
Mr Checkbox
Check this box if your title is Mr.
Mrs Checkbox
Check this box if your title is Mrs.
Miss Checkbox
Check this box if your title is Miss.
Ms Checkbox
Check this box if your title is Ms.
Mx Checkbox
Check this box if your title is Mx.
Other Title Text
Please specify your title if it is not listed among the standard options. Fill only if 'Mx' is checked.
Depends on: Mx
Family Name Text
Please enter your family name, also known as your surname or last name.
First Given Name Text
Please enter your first given name.
Second Given Name Text
Please enter your second given name, if applicable.
Payment Account Details
No Checkbox
Check this box if you do not want your payment made into an account where you currently receive other payments from Services Australia.
Yes Checkbox
Check this box if you want your payment made into an account where you already receive other payments from Services Australia.
Previous Payment Name Text
Please provide the name of a payment that was previously made into this account. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Additional Payment Name Text
Please provide another name of a payment that was previously made into this account, if applicable. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Permanent Address
Street Address Text
Please provide the street number, street name, and any other relevant address details for your permanent residence.
Suburb/City/State Text
Please provide the suburb, city, and state of your permanent residence.
Postcode Text
Please provide the postcode of your permanent residence.
Max length: 4 characters
Postal Address
Postal Address Line 1 Text
Please provide the first line of your postal address.
Postal Address Line 2 Text
Please provide the second line of your postal address.
Postal Postcode Text
Please provide the postcode for your postal address.
Max length: 4 characters
Previous Year 12 Attempt Details
No Checkbox
Check this box if you have not attempted Year 12 before. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Yes Checkbox
Check this box if you have attempted Year 12 before. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Year 12 First Attempt Date Date
Provide the date when you first attempted Year 12. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Year 12 Second Attempt Date Date
Provide the date when you made a second attempt at Year 12. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Other Year 12 Attempt Date Date
Provide the date of any other attempt at Year 12. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Second Past Post Secondary Study
Second Study Years Text
Please enter the years during which the second past post-secondary study was undertaken.
Full-time Checkbox
Check this box if the second past post-secondary study was undertaken on a full-time basis.
Part-time Checkbox
Check this box if the second past post-secondary study was undertaken on a part-time basis.
Second Study Institution Name Text
Please enter the name of the institution or campus where the second past post-secondary study took place.
Second Study Course Name Text
Please enter the name of the second past post-secondary course undertaken.
No Checkbox
Check this box if you did not complete the second past post-secondary course.
Yes Checkbox
Check this box if you completed the second past post-secondary course.
Startup Year Course Study
No Checkbox
The user should check this box if they are not studying a Startup Year course.
Yes Checkbox
The user should check this box if they are studying a Startup Year course.
DummyCalcQ14 Text
Depends on: Yes
Study Break Information
No Checkbox
Check this box if you are not returning to study after a break of more than one semester in a full year course.
Yes Checkbox
Check this box if you are returning to study after a break of more than one semester in a full year course.
Last Study Date (Day Month) Text
Please enter the day and month you last studied.
Last Study Date (Year) Text
Please enter the year you last studied. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Third Past Post Secondary Study
Study Years Text
Please enter the years during which this post-secondary study was undertaken.
Full-time (Study 3) Checkbox
Check this box if the third past post-secondary study was undertaken on a full-time basis.
Part-time (Study 3) Checkbox
Check this box if the third past post-secondary study was undertaken on a part-time basis.
Institution Name Text
Please provide the name of the institution or campus where this post-secondary study was undertaken.
Course Name Text
Please enter the name of the course for this post-secondary study.
Did you complete this course? No (Study 3) Checkbox
Check this box if you did not complete the third past post-secondary course.
Did you complete this course? Yes (Study 3) Checkbox
Check this box if you completed the third past post-secondary course.
Veterans' Affairs Pension Details
No Checkbox
Check this box if you do not receive a pension from the Department of Veterans' Affairs.
Yes Checkbox
Check this box if you receive a pension from the Department of Veterans' Affairs.
Name of Payment Text
Enter the name of the pension payment received from the Department of Veterans' Affairs.
Payment Description Text
Provide a detailed description of the Veterans' Affairs pension payment. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Veterans Affairs Reference Number Text
Enter the reference number associated with your Veterans' Affairs pension. Fill only if 'Yes' is 'Yes'.
Depends on: Yes
Payment Start Date Date
Enter the date when the Veterans' Affairs pension payment began. Fill only if 'Yes' is 'Yes'.
Max length: 10 characters
Depends on: Yes
Year 12 Study Claim
No Checkbox
Check this box if this claim is not for Year 12 study.
DummyCalcQ15 Text
Yes Checkbox
Check this box if this claim is for Year 12 study.