Domestic Students Application Form

Domestic 2

Step 1 of 9

Your personal details
We will contact you be email or telephone. To avoid delays in your application, it is important you complete ALL of your details clearly including your email address.
Name (as shown in ID)*
First Middle Last
Gender*
Date of Birth*
Email*
Telephone*
Residential Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

*MUST include postcode
Mailing address (if different from above):
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

*MUST include postcode

Emergency Contact
*Student's immediate family only
Name
First Last
Relationship to applicant*
Phone
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Unique Student Identifier (USI)
Unique Student Identifier Number (please provide if known)
From 1st January 2015, all students undertaking a nationally recognised training delivered by a registered training organisation will need to have a USI. The Unique Student Identifier or USI is a reference number made up of 10 numbers and letters.
USI Consent
If you would like InTech to apply for a USI on your behalf you must authorise us to do so and declare that you have read the privacy information at https://www.usi.gov.au/about-us/privacy
- No, I don't have a USI number. I consent Intech Institute on my behalf.
- No, I don't have a USI number. I will create one myself.
If you have not yet obtained a Unique Student Identifier (USI) you can apply for it directly at https://www.usi.gov.au/students/create-your-usi

Program choices*

Course Code (eg. AUR20516)	Course Title (eg. Cert II in Auto Servicing Tech)	Proposed Start Date

Indicate up to two program choices, in preferential order. If you are not eligible for the first program choice, you will be considered for the second program choice. Where applicable you may be considered for alternate programs other than the two you select.

Delivery method:
- On Campus
- Online
- RPL (Recognition of Prior Learning)
- Workplace

Queensland Government Department of Education and Training Funded programs
Tick where applicable
- I declare that advice has been provided to me concerning expectations and rules regarding QLD government funded training programs offered at Intech
- VET in Schools: I acknowledge that I will no longer be eligible for a government subsidised training place under the VET in schools program once I have completed the Certificate I or II level qualification
- Certificate III Guarantee: I acknowledge that I will no longer be eligible for a government subsidised training place under the Certificate III Guarantee program once I have completed the Certificate III or higher-level qualification
- Higher Level Skills: I acknowledge that I will no longer be eligible for a government subsidised training place under the Higher Level Skills program once I have completed the Certificate IV or higher-level qualification

Domestic 2

Step 1 of 9

Program Choice

Your personal details

Emergency Contact

Unique Student Identifier (USI)

Previous academic qualifications

Supporting Documents

Other Personal Details

Students with a disability/health condition

Employment details - for apprenticeship/traineeship

Job Service Provider (if applicable)

Queensland Government Department of Education and Training Funded programs

Student Declaration

Quick Links

College Info

Our Campuses

School name	Course

Domestic students application form

Domestic 2

Step 1 of 9

Program Choice

Your personal details

Emergency Contact

Unique Student Identifier (USI)

Previous academic qualifications

Supporting Documents

Other Personal Details

Students with a disability/health condition

Employment details - for apprenticeship/traineeship

Job Service Provider (if applicable)

Queensland Government Department of Education and Training Funded programs

Student Declaration

Quick Links

College Info

Our Campuses

Contact Us