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Ready Set Uni – Application Form
Ready Set Uni: Year 12 Program – Application Form
Please enable JavaScript in your browser to complete this form.
First Name
*
Last Name
*
Preferred Name
If different from your first name
Pronouns
How would you like to be referred to during this program? E.g. He/His, She/They
Date of Birth
*
Gender
*
Male
Female
Intersex
Non-Binary
Prefer not to say
Email
*
Confirm Email Address
*
Mobile Phone
*
Home Address
*
Are you of Aboriginal or Torres Strait Islander heritage?
*
Yes
No
Prefer not to answer
Has anyone in your family completed a university degree?
*
Yes
No
Does your family speak any language other than English?
*
Yes
No
I will be completing Year 12 in 2025
*
Yes
No
What is your Unique Student Identifier (USI)?
*
A USI is a reference number which is made up of a combination of ten numbers and letters, that is free and easy to create and stays with you for life. To find your USI, use this link https://www.usi.gov.au/students/get-a-usi
I am completing High School at
*
Leeton High School
Marian Catholic College
Murrumbidgee Regional High School - Griffith Site
Murrumbidgee Regional High School - Wade Site
St Francis De Sales College
Verity Christian College
Yanco Agricultural High School
Other
If other, please specify below
If you indicated "Other" above, please specify which High School you are attending
Do you have any medical conditions, learning disabilities or other additional needs?
*
Yes
No
If you indicated "Yes" above, please outline details
Known Allergies/Dietary Requirements
Parent/Carer Full Name
*
Parent/Carer's Relationship to the Student
*
Parent/Carer Email Address
*
Parent/Carer Phone Number
*
I (the student) affirm that I have read the Student Agreement as outlined in Program Information/Consent Form, and agree to the Student Agreement/any other relevant documents or policies provided by the CUCWR.
*
Yes
No
Students who do not accept and adhere to the rules provided in the Student Agreement will be removed from the Program.
I (the parent/carer) acknowledge that I have read, understand, and agree to the terms outlined in the document, without limitation. I further understand that my consent, and the provision of my child’s personal information, is necessary for their participation in the CUCWR services.
*
Yes
No
CUCWR will handle all personal information in accordance with our Privacy Policy and ensure compliance with the Privacy Act 1988.
We may have a photographer taking photos of students during the program. I (the parent/carer) give my consent to photographing and video recordings, containing images of my child obtained by Country Universities Centre (CUC) being used by CUCWR free of charge for CUC publications/presentations, in CUC websites/social networking sites, in media including newspaper/magazine/television/radio/film; in research and evaluation.
*
Yes
No
CUCWR will handle all media content in accordance with our Privacy Policy and ensure compliance with the Privacy Act 1988. By agreeing to the above, I understand that images may be published from time to time by CUC and while I can withdraw my consent for the use of the images/videos in further publications at any time, I understand and agree that images that have already been published could be viewed in the future and that CUC may be unable to prevent this from occurring.
I would like to attend the Ready Set Uni Program in:
*
Leeton (Wednesday 4-5pm)
Online - Zoom (Wednesday 4-5 pm)
Griffith (Thursday 4-5pm)
Online - Zoom (Thursday 4-5 pm)
Any concerns or requests regarding sessions, please contact Maddi on 0419 540 956 or maddison.ramponi@cucwesternriverina.edu.au
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