College Admissions Form

Name*

First NameMiddle InitialLast Name

Birth Date*

MonthDayYear

Gender*

MaleFemale

E-mail Address*

example@example.com

Phone*

Student Number

Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Do you speak any languages other than English?*

YesNo

Do you do a Diploma or a Bachlor in Community Services?*

DiplomaBachelor

Is it your first or second placement?*

1st Placement2nd Placement

Did you find this placement via the list provided by your campus manager?*

YesNo

Did you talk to an Academic about your chosen organisation?*

YesNo

Have you previously worked with this organisation?*

YesNo

Have you been referred to this organisation by a friend (another AE student)?*

YesNo

If yes, please provide the name of the student below:

Please attach your Sourcing Placement Form below:*

Please confirm all the downloaded information (Sourcing Placement Form/s) above is correct*

CONFIRMED

Please confirm you understood the above statement:*

I understand

Please confirm that all the information above is correct*

CONFIRMED

Student Placement Request Form