Registration Form: Adult Students -2015 Senier External Examination

Registration form – Adult students
2015 Senior External Examination

Eligibility

/ I will be 17 years or older by the end of 2015.
/ I will be 16 years or younger by the end of 2015 and have not yet completed Year 12. My eligibility application was approved earlier this year
/ I will be 16 years or younger by the end of 2015. My Eligibility form is attached. I understand that if my application is not approved, my registration fee will be refunded

Personal details

Title / / Mr / / Ms
Family name / Given names / Date of birth
Postal Address / Suburb / State / QLD / Postcode / 4
Phone number / Email

*Contact us if you are not a Queensland resident

LUI (Learner unique identifier)

/ If you don’t know your LUI, check with your teaching centre

Examination centre

You must sit all your written examinations at the same centre. If you live more than 80 kilometres from an existing centre, you may apply to sit at an alternative centre. Contact us for more information.

Preferred examination centre

Subjects and teaching centres

Select the subjects you are registering for and where you have been studying for these examinations

Subjects / Teaching centre

Candidate’s declaration

I agree to comply with the Education (Queensland Curriculum and Assessment Authority) Regulation 2014 Part 3 as well as the examination rules and timetable for the Senior External Examination (

Payment options

Payment received by 30 June 2015 - $57.10 per subject.

Payment received after 30 June 2015 - $62.65 (Registrations received after this date may not be accepted)

/ Bank deposit / Provide your name in the payee/remitter’s field so we can match payment with your registration form
Commonwealth Bank BSB: 064013, Account No: 10008515
Payment total / $ / Payment date / / / /
/ Credit card / Card number / Expiry date / / / / Payment total / $
Cardholders name / Cardholder’s signature
/ Cash/EFTPOS
(in person only) / Payment total / $
QCAA use only / Receipt no. / Payment date / / / /

Returning this form

If you are paying by:

Bank deposit / Complete onscreen, save and email to
Credit card / Complete onscreen, print and sign in the space provided then scan and email to
Cash/EFTPOS/Cheque / Complete onscreen, save and email to . Payment must be made within 7 days at
QCAA, Level 7, 154 Melbourne Street, South Brisbane.

This information you provide on this form will be used for administering and managing registrations as part of legislative functions described in Education (Queensland Curriculum and Assessment Authority) Regulation 2014 (s.57). Personal information will be accessed by authorised QCAA staff, and handled in accordance with the Information Privacy Act 2009. Certain types of personal information will be disclosed to your teaching and examination centres, the Queensland Tertiary Admissions Centre (QTAC and other authorised government agencies where legally required.