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4. Course Reinstatement Form - International Students

Course Reinstatement Form - International Students

Required fields are marked with an asterisk (*).

Personal Details

Student ID

Family Name *

Given Names/First Names *

Date of Birth *

Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJunJulAugSepOctNovDec Year 19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099

Course Name *

Course Code *

Personal Contact Details

Mailing Address

Address Line 1 *

Address Line 2

Town/Suburb *

State *

-- Please Select --ACTNSWNTQLDTASVICWA

Postcode * Please enter your postcode in 4 digit format (No spaces, no characters)

Telephone Number * (2 Digit Area Code + 8 Digit Number)

Email *

Residential Address Preference

Is your Residential Address the same as your Mailing Address? *

-- Please Select --YesNo

Residential Address

Address Line 1 *

Address Line 2

Town/Suburb *

State

-- Please Select --ACTNSWNTQLDTASVICWA

Postcode * Please enter your postcode in 4 digit format (No spaces, no characters)

Acceptance

I have read and accept the Privacy Statement and Declaration *

• Yes