Application form

Your Personal details

Title*:	Mr Ms Other
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
Nationality*:	--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 v 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
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 v 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
Do you hold a current visa to be in Australia?    Yes No
If yes, visa type number, expiry date and conditions:

Contact details:

Address in Australia (if known)

Address:
Suburb and Postcode:
Home telephone*:	-
Mobile telephone*:	-

Address overseas
(must be applicant's address – not agent's address)

Address:
Email address*: (must be applicants email – not agent's email)

Emergency Contact Details:

Name:
Relationship:
Telephone number:
Email:

I authorise ACAP to seek appropriate medical care for me, as a matter of urgency, in the event of circumstances during on-campus classes requiring urgent medical care when it is not possible to contact my parent/guardian or next of kin.

Education details

Secondary Education – highest level achieved

Name of qualification (eg. Year 12):
School attended:
Completed:	Yes No
Country/State:
Language of instruction:

Tertiary and Further Education

Have you previously enrolled in any further postsecondary school studies in Australia or overseas?   Yes No
Name of qualification:
Institution attended:
Completed:	Yes No
Expect to complete this year:	Yes No

What is the highest level of education completed by your parent/s or guardian/s?

Parent/ Guardian 1:

Male Female --Select-- Postgraduate (e.g. GradDip, Masters, PhD) Bachelor degree Other post-school qualification (e.g. associate degree, diploma, advanced diploma) Completed apprenticeship and/or VET/TAFE certificate Completed Year 12 schooling (or equivalent) Completed Year 10 schooling (or equivalent) continued at school, but did not complete year 12 Completed Year 10 schooling or equivalent Left school before completing Year 10 Do not know

Parent/ Guardian 2:

Male Female --Select-- Postgraduate (e.g. GradDip, Masters, PhD) Bachelor degree Other post-school qualification (e.g. associate degree, diploma, advanced diploma) Completed apprenticeship and/or VET/TAFE certificate Completed Year 12 schooling (or equivalent) Completed Year 10 schooling (or equivalent) continued at school, but did not complete year 12 Completed Year 10 schooling or equivalent Left school before completing Year 10 Do not know

English Language

What is your current English language level?

IELTS (Academic) or TOEFL score:
Other (please specify):
What is the main language that you speak at your permanent home address? English Other

Employment history:

If you are applying for a postgraduate course please attach a certified copy of your undergraduate degree, and a copy of your resume.
Upload

Course selection:

Please select the course that you are interested in:

	Bachelor of Applied Social Science
	Graduate Diploma of Counselling
	Master of Applied Social Science (Counselling)
	Master of Applied Social Science (Management)
	Bachelor of Psychological Science
	Graduate Diploma of Psychological Science
	Bachelor of Psychological Science (Honours)
	Graduate Diploma of Psychology

Note: ACAP reserves the right to offer its courses subject to meeting minimum numbers and may cancel a course prior to commencement should the minimum number of enrolments not be met.

Please select the campus that you are interested in studying at:

Sydney	Brisbane	Melbourne
Flexible delivery from your home country

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

Overseas Student Health Cover (OSHC)

Note: You only need to complete this section if you are intending to study with ACAP on a student visa.

Please tick if you want your e-mail address provided to our OSHC provider. If you already have OSHC, please provide details:
OSHC provider's name:
Your membership number:

Medical / Disability:

Do you have a disability, impairment or long-term medical condition which may affect your studies? No yes Please indicate the areas of impairment:

Hearing Vision Learning Medical Mobility Other, please specify:

Would you like to receive advice regarding services and facilities available? No yes
Are there any other circumstances that you are aware of that may revent you from completing the course you wish to enrol in?NoYes
	If yes, please specify:

Application Checklist

Check that you have:

Completed all sections of this form

Check that you have attached:

	Attach abrief statement in English (approximately 150 words) describing how your interest in the course relates to your career aspirations
	Certified copies of qualifications attained, including English translation if applicable
	A copy of the first page of your passport
	A copy of your Australian visa

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:

Privacy, Declaration and Terms & Conditions

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 an international student in a course at ACAP. I declare that all information submitted is correct 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 authorise ACAP to obtain further academic 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 authorise ACAP to release any personal information held about me to the Department of Immigration and Citizenship (DIAC) and the Department of Education, Employment and Workplace Relations (DEEWR), should I enrol at ACAP. 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 understand that I am protected by the Education Services for Overseas Students (ESOS) legislative framework available at, http://aei.dest.gov.au/AEI/ESOS/QuickInfo/ESOS_FrameWork_pdf.pdf This is an agreement between provider and student. This agreement, and the availability of complaints and appeals processes, does not remove the right of the student to take action under Australia's consumer protection laws. I am aware that the ACAP Student Handbook is available on-line at www.acap.edu.au. By signing this 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 delcare that the information I have supplied on this form is, to the best of my understanding and belief, complete and correct. I have read, understand and accept the Terms and Conditions pertaining to this application.

Yes No