Tertiary Student Enrolment Declaration Instructions
This form contains 30 fields organized into 6 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Campus 1 | ||
| Name of Educational Institution | Text |
Please enter the full name of the educational institution.
|
| Campus Location Address | Text |
Please enter the physical address of the campus you attend.
|
| Campus City/Suburb | Text |
Please enter the city or suburb of the campus location.
|
| Postcode | Text |
Please enter the postcode of the campus location.
|
| Enrolment Start Date | Date |
Please enter the start date of your enrolment at this campus.
|
| Enrolment End Date | Date |
Please enter the end date of your enrolment at this campus.
|
| Campus 2 | ||
| Campus 2 Institution Name | Text |
Please enter the name of the educational institution for Campus 2.
|
| Campus 2 Location Address Line 1 | Text |
Please enter the first line of the physical address of Campus 2.
|
| Campus 2 Location Address Line 2 | Text |
Please enter the second line of the physical address of Campus 2, such as the suburb or city.
|
| Campus 2 Postcode | Text |
Please enter the postcode for Campus 2.
|
| Campus 2 Enrolment From Date | Date |
Please enter the start date of your enrolment period at Campus 2.
|
| Campus 2 Enrolment To Date | Date |
Please enter the end date of your enrolment period at Campus 2.
|
| Customer Reference Number | ||
| Customer Reference Number Part 1 | Text |
Please enter the first part of your Customer Reference Number.
|
| Customer Reference Number Part 2 | Text |
Please enter the second part of your Customer Reference Number.
|
| Customer Reference Number Part 3 | Text |
Please enter the third part of your Customer Reference Number.
|
| Customer Reference Number Part 4 | Text |
Please enter the fourth part of your Customer Reference Number.
|
| General | ||
| Instructions | Button | |
| Q3a.CampusAddress.0 | Text | |
| Q3a.CampusAddress.1 | Text | |
| Q3b.CampusAddress.0 | Text | |
| Q3b.CampusAddress.1 | Text | |
| Print button | Button | |
| Clear button | Button | |
| Page 2 | ||
| Your Signature | Text |
Please enter your full name as your signature. Fill only if '3b - Campus 2' section is filled
Depends on:
Campus 2 Institution Name, Campus 2 Location Address Line 1, Campus 2 Location Address Line 2, Campus 2 Postcode, Campus 2 Enrolment From Date, Campus 2 Enrolment To Date
|
| Declaration Date | Date |
Please provide the date of your declaration. Fill only if '3b - Campus 2' section is filled
Depends on:
Campus 2 Institution Name, Campus 2 Location Address Line 1, Campus 2 Location Address Line 2, Campus 2 Postcode, Campus 2 Enrolment From Date, Campus 2 Enrolment To Date
|
| Your details | ||
| Family Name | Text |
Please provide your family name.
|
| First Given Name | Text |
Please provide your first given name.
|
| Second Given Name | Text |
Please provide your second given name.
|
| Date of Birth | Date |
Please provide your date of birth.
|
| Student Identification Number | Text |
Please provide your student identification number.
|