Section 1 Applicant Details Date Attended Information Session Family Name * Given Name(s) * Sex *
Date of Birth * Parent/Guardian Name(s) Residential Address * Residential Suburb/City * Residential State * QLD NSW VIC ACT TAS SA WA NT Residential Postcode * Postal Address Postal Suburb/City Postal State QLD NSW ACT VIC TAS SA WA NT Postal Postcode Guardian Email Guardian Home Phone * Guardian Business Phone Guardian Mobile Guardian Facsimile Residential Status *
Country of Birth * To enable Tec-NQ to provide special assistance where necessary, please select: Are you of Aboriginal or Torres Strait Islander origin? No Aboriginal Torres Strait Islander Aboriginal and Torres Strait Islander Are you a mature age student? (18+)
Yes
No
If yes, what is your highest level of study? Year completed Please nominate your top three preferences in the following trade areas: Preference 1 * - Carpentry Electrical Fitting & Turning Light Vehicle Automotive Plumbing Boilermaking Panel Beating Heavy Vehicle Automotive Spray Painting Diesel Fitting Sheet Metal IT Business Preference 2 - Carpentry Electrical Fitting & Turning Light Vehicle Automotive Plumbing Boilermaking Panel Beating Heavy Vehicle Automotive Spray Painting Diesel Fitting Sheet Metal IT Business Preference 3 - Carpentry Electrical Fitting & Turning Light Vehicle Automotive Plumbing Boilermaking Panel Beating Heavy Vehicle Automotive Spray Painting Diesel Fitting Sheet Metal IT Business What is your preferred mode of correspondance? * Email Post Fax Where did you hear about us? * Television Newspaper Radio Word of Mouth/Friend Internet Open day or trade show Other Name of friend / event / station / publication Section 2 Education History Current School Year Level Most recent school results for: English Maths Have you been involved in any prior School-based Vocational Education programs? Yes/No
Yes
No
Program Outcome Section 3 must be completed by a parent/guardian The answers to these questions will not affect your application to the college. The information will allow us to assess how to most effectively meet your needs. Does your son/daughter have special learning needs?
Yes
No
Please specify: Is your son/daughter from a non-English speaking background?
Yes
No
If yes, what language is spoken at home? Does your son/daughter require assistance with English?
Yes
No
Does your son/daughter have a disability/impairment or long term condition?
Yes
No
If yes please indicate a category: - Intellectual Social/emotional Dyslexia Physical Autistic Spectrum Disorders Visual Impairment Hearing Learning Aquired Brain Impairment Mental Illness Other Does you son/daughter have a medical condition that may affect his/her studies?
Yes
No
If yes, please specify: - Asthma Colour Blindness Epilepsy Allergies Other Further Information 
