APPLICATION FORM

For full-time / part-time study

IMPORTANT: Use this application for Polytechnic West only. Prospective students using this form should be aware that applications submitted to TAFE Admissions, using the TAFE Admissions application form, are given priority. Polytechnic West Standby Applications are only considered for any places remaining after the TAFE Admissions process is complete. If the course you are applying for is offered as a direct entry then this will not apply. Please ask for clarification on your specific course if required.

Applicant Name ______

Course Name Campus

1st preference ______

2nd preference ______

3rd preference: ______

Once complete, please return this application to:

or

Fax – Attention: Chantal Johnson – 9374 6420

or

Polytechnic West Applications

PO Box 1336

MIDLAND WA 6936

or

Drop the application into Polytechnic West Midland campus (see back page for details)

Call Chantal Johnson for enquires – Ph:9374 6448

NB: Please make sure all relevant documentation is attached before submitting your application (see back page for details).

Survey - please tick the boxes that apply

Male

Female

15-19

20-29

30-39

40-49

50-59

60+

You live in (suburb) ______

How did you find out aboutyour course/Polytechnic West?

(Tick as many boxes as you like)

Polytechnic West Website Received mail or email from Polytechnic

polytechnic.wa.edu.au West

Training WA website Phoned Polytechnic West

trainingwa.wa.edu.au

Phoned or visited the Career Visited a Polytechnic West campus (which

Development Centre (in Perth) one) ______

Friends, family, work Polytechnic West careers advisers visited

(word-of-mouth) my school this year

Community Newspaper Advertising West Australian Advertising

xPress Newspaper Expo(s) (which one)

______

Read an article in a newspaper Other please specify

______

______

Personal Details

Surname/Family Name ______

First/Given Name(s) ______

Birth Date ______Gender Male Female

Address ______

Postcode ______

Phone Home ______Phone Work ______

Mobile Phone ______

Citizenship and Residency Status
Country of Birth: ______

If you were not born in Australia

You must provide evidence to show that you are either:

-  a permanent resident or citizen of Australia; or

-  a permanent resident or citizen of New Zealand; or

-  that you have one of the following visa sub-classes

309 310 820 826

Current Secondary Studies
Are you currently in secondary study? Yes No
If so, which year are you in? ______

Previous Secondary Studies

Please tick the appropriate box to indicate your highest completed year of secondary study:

Less than year 10 Year 10 Year 11 Year 12

In what year did you complete the above? ______

At which school/college? ______

Have you completed an Adult Tertiary Entrance Test?

10T Test When/Where? ______

STAT Test When/Where? ______

Previous or Current TAFE Studies
Course No / Course title / Campus / Completed Y/N / Completing course this semester Y/N

Other Studies

Have you completed any other studies you wish to be considered? (Please provide details)

______

______

Employment, Workplace Experience or Voluntary Activities
(Proof of these must be supplied. ie: payslips, reference letters, group certificates)
Name of Employer/Organisation / Type of Work/Activities / Dates
From To / P/T or F/T
Casual
Special Needs

Are you likely to require special assistance as a student (for example, mobility impairment, special text, Braille, translators etc)?

Yes No

If yes, please provide information regarding your anticipated requirements:

______

______

______

Declaration

By emailing or submitting this declaration, I understand that this Polytechnic West Standby Application cannot be considered until after the TAFE Admissions process is complete, and certify that the information provided in this Polytechnic West Standby Application is true and correct.

Name/Signature: ______

Date: ______/______/______

Please attach PHOTOCOPIES of the following documents to this application form:

-  Your year 9,10,11 and12 school reports (as applicable);

-  Proof of work experience (references, pay slips, Group Certificates etc);

-  Your resume;

-  Proof of Australian/New Zealand Citizenship or Permanent Residency (if you were not born in Australia or New Zealand); and

-  Any other supporting documentation which you believe may enhance your application.

For further assistance please contact Polytechnic WA on 9267 7500

Armadale Campus

40 Commerce Ave, Armadale 6112

Balga Campus

18 Loxwood Rd, Balga 6061

Bentley Campus

Hayman Rd, Bentley 6102

Carlisle Campus

Cnr Oats and Banks Sts, Carlisle 6101

Midland Campus

Cnr Lloyd St and Eddie Baron Drive, Midland 6056

Thornlie Campus

Burslem Drive, Thornlie 6108

This document is available in alternative formats.

Please contact disability services on 9267 7748 for more information.