Application form

Personal details

Title*:	Mr Ms Miss Mrs Dr Other - specify:
Family Name*:
Given Name*:
Preferred Name:
Date of birth:	Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 - Month 01 02 03 04 05 06 07 08 09 10 11 12 - Year
Gender:	Male Female

Contact details

Home telephone*:	-
Telephone (other):	-
Mobile telephone*:	-
Fax:	-
Email*:
Home Address:
Suburb:
State & Postcode:
Country*:	--Select-- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See / Vatican City Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Korea, Democratic Peoples Rep Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Authority Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/South Sandwich Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu USA US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
Postal Address: (if different from above)
Suburb:
State & Postcode:
Country*:	--Select-- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See / Vatican City Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Korea, Democratic Peoples Rep Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Authority Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/South Sandwich Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu USA US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe

Citizenship

Nationality/ Country of Birth:	--Select-- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Ascension Island Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Channel Islands Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic of Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Holy See / Vatican City Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Korea, Democratic Peoples Rep Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Authority Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/South Sandwich Spain Sri Lanka St. Helena St. Kitts and Nevis St. Lucia St. Pierre and Miquelon St. Vincent and Grenadines Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu USA US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands (British) Virgin Islands (U.S.) Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
Are you an Australian Citizen? Yes No
Are you an Australian Permanent Resident or New Zealand Citizen? Yes No Note: Students who are not Australian Citizens, Australian Permanent Residents or New Zealand Citizens must complete the international Application form.
Are you on a permanent Humanitarian Visa? Yes No
Are you Aboriginal? Yes No
Are you Torres Strait Islander? Yes No
Are you both Aboriginal and Torres Strait Islander? Yes No
What is the main language spoken at your home address? English Other - please specify:

Tertiary and further education

What is your highest completed secondary school level? Year 10 or lower Year 11 Year 12
School:
Year of completion:
UAI/ATAR/HSC/OP or equivalent:
Are you applying to study under Mature Age Entry Provision (21 years and over)?   Yes No
Have you successfully completed any further qualifications?
Qualification: Institution: Completed: Last year of attendance: Yes No Yes No Yes No
Are you applying for credit for previous study (eg. Recognition of Prior learning, Articulation or Credit Transfer)? Yes - a separate application is required - please contact ACAP for more information. No
Parent/Guardian 1 education
Male	Female
What is the highest level of education completed by your parent/s or guardian/s? --Select-- Postgraduate (e.g) Grad Dip, Masters, PhD) Bachelor Degree Other post school qualification (e.g associate degree, diploma, advanced diploma) Completed apprenticeship or VET/TAFE Certificate Completed year 12 schooling (or equivalent) Completed year 10 schooling (or equivalent) Continued at school, but didn't complete year 12 Completed year 10 schooling or equivalent Left school before completing year 10 Don't know
Parent/Guardian 2 education
Male	Female
What is the highest level of education completed by your parent/s or guardian/s? --Select-- Postgraduate (e.g) Grad Dip, Masters, PhD) Bachelor Degree Other post school qualification (e.g associate degree, diploma, advanced diploma) Completed apprenticeship or VET/TAFE Certificate Completed year 12 schooling (or equivalent) Completed year 10 schooling (or equivalent) Continued at school, but didn't complete year 12 Completed year 10 schooling or equivalent Left school before completing year 10 Don't know

Course selection

Please select the course that you are interested in:

	Diploma of Community Services (Case Management) (CHC52008)
	Diploma of Counselling (CHC51708)
	Diploma of Human Resources Management (BSB50607)
	Bachelor of Applied Social Science
	Master of Applied Social Science (Management)
	Graduate Diploma of Counselling
	Master of Applied Social Science (Counselling)
	Bachelor of Psychological Science
	Bachelor of Psychological Science (Honours)
	Graduate Diploma of Psychological Science
	Graduate Diploma of Psychology
	Graduate Certificate in Elite Athlete Mentoring
	Graduate Diploma of Elite Athlete Mentoring
	Single Module (Undergraduate)(Non-Award)
	Single Module (Postgraduate)(Non-Award)

Note: Courses run subject to minimum numbers and ACAP reserves the right to cancel a course that does not meet minimum numbers prior to commencement.

ACAP Course Commencement

Please indicate the year and term you wish to begin your studies.

Year:

Term 1 February

Term 2 June

Term 3 September

Summer School January

Please note: Not all courses are available at all campuses. Please check www.acap.edu.au for the latest course information.

Other information

How did you first learn about ACAP? You may tick more than one:

	Education Agent
	Internet
	Recommended by a friend/relative
	Exhibition/Seminar
	Newspaper/Magazine
	Website
	Other, please specify:

Application Checklist

Please ensure the following are included with your application, otherwise there will be a delay in processing.

	This application completed in full
	A brief statement in English (approximately 150 words) describing how your interest in the course relates to your career aspirations
	Completed online Request for FEE-HELP Assistance Form (if applicable)
	Certified* copies of all academic qualifications, including English translation if applicable
	Certified* copy of proof of age (Undergraduate and Vocational course applicants)
	An up-to-date resume (Master of Applied Social Science applicants)
	Evidence of 2 years work experience (Diploma of Human Resources Management applicants)

	This application completed in full
	If applying for the Bachelor of Psychological Science:
	A brief statement in English (approximately 500 words) describing how your interest in the course relates to your career aspirations
	If applying before your ATAR is available a copy of your most recent school report (school leavers)
	If applying for the Bachelor of Psychological Science (Honours), Graduate Diploma of Psychological Science or Graduate Diploma of Psychology:
	Certified* copies of all academic qualifications, including English translation if applicable

Upload

* A certified copy is a photocopy signed by an authorised officer to acknowledge that it matches the original document exactly. Authorised officers are: Justice of the Peace, Lawyer/Solicitor, Police Officer, Teachers and University Professors.

Privacy Statement & Declaration

Privacy Statement ACAP collects, stores and uses personal information only for the purposes of administering prospective, current and graduate student admissions, enrolment and education. The information provided is confidential and will not be disclosed to third parties without your consent and without due cause, except to meet government, legal or other regulatory requirements for normal operation of ACAP. You have the right of access to and alteration of, the information concerning yourself in accordance with the Privacy and Personal Information Act, 1988 (NSW) For more information please refer to www.acap.edu.au. Declaration Important: This document contains and refers to contractual terms. I wish to be considered for enrolment as a student in a course at ACAP. I declare that all information submitted is correct, true and complete and that I can and will produce to the Australian College of Applied Psychology originals of all submitted documentation on request. I understand that depending on the course I enrol in I will need to complete practical experience placements, and I will be required to complete a Prohibited Employment Declaration for each period of practical experience placement (in accordance with Child Protection (Prohibited Employment) Act 1998) and a Criminal Record check. If I am unable to provide a satisfactorily completed Prohibited Employment Declaration or Criminal Record Check as and when requested by ACAP, I will not be eligible to participate in practical experience placements. I understand that if I am unable to satisfactorily complete any one or more practical experience placement requirements I will be unable to complete the course. I understand that if ACAP is required by law, or considers it appropriate for public policy reasons (including health and safety), to close any campus, ACAP may require on-campus students to receive tuition via flexible delivery for such time as the campus is closed. I authorise ACAP to obtain further information or official student records from any educational institution or recognised educational qualifications assessment body necessary and/or, where my work experience is relevant, to verify my employment history for the purposes of making an informed decision about my application. I acknowledge that ACAP reserves the right to vary or reverse any decision regarding admission made on the basis of incorrect, incomplete or fraudulent information. I am aware that the ACAP Student Handbook is available on-line at www.acap.edu.au. By submitting this online form I acknowledge that I have read and understood the policies, procedures and terms set out in the ACAP student Handbook and I agree to be bound and abide by the policies, procedures and terms set out in the Student Handbook as amended from time to time. I acknowledge and agree that the acceptance of my application by ACAP is conditional upon my agreement to be bound and abide by the policies, procedures and terms set out in the Student Handbook as amended from time to time. I am aware that ACAP, as an approved Higher Education Provider (HEP), is required to collect the information on this form from all students, and is doing so for the purpose of assessing my admission entitlement and entitlement to Commonwealth Assistance under the Higher Education Support Act 2003 and allocation of a Commonwealth Higher Education Student Support Number (CHESSN) to me; ACAP will disclose this information to the Department of Education, Employment and Workplace Relations (DEEWR) for these purposes. DEEWR will store the information securely in the Higher Education Information Management System, and may disclose the information to the Australian Tax Office and other designated authorities. ACAP and DEEWR will not otherwise disclose the information without my consent unless required or authorised by law. I declare that the information I have supplied on this form is, to the best of my understanding and belief, complete and correct. Important: This document contains and refers to contractual terms. I wish to be considered for admission as a domestic student in a course at ACAP. I declare that all information submitted is correct and complete and that I can and will produce to ACAP originals of all submitted documentation on request. I authorise ACAP to obtain further academic information or official student records from any educational institution or recognised educational qualifications assessment body necessary for the purposes of making an informed decision about my application. I acknowledge that ACAP reserves the right to vary or reverse any decision regarding admission made on the basis of incorrect, incomplete or fraudulent information.

Yes No