In2Uni Year 12 University Preparation Program 2020 Application Form

1. Personal Details
Name Name * First Middle Last
Gender *

Gender Female Male X
Date of Birth Date of Birth * / DD / MM YYYY
Are you of Aboriginal or Torres Strait Islander descent? *

Are you of Aboriginal or Torres Strait Islander descent? Yes No Prefer not to answer
Has anyone in your family attended University? *

Has anyone in your family attended University? Yes No
Are you an Australian citizen? *

Are you an Australian citizen? Yes No
Please upload a copy of your birth certificate or Australian current, non-expired passport passport *

Attach Files

Please ensure that files uploaded are in a PDF or JPG format.
If you are a permanent resident or on a humanitarian VISA, please upload a copy of your current, non-expired passport (first page only) AND a copy of your VISA Grant Notice *

Attach Files

Please ensure that files uploaded are in a PDF or JPG format.
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
All mail will be mailed to this address unless postal address supplied
Is above address the same as postal address? *

Is above address the same as postal address? Yes No
Postal Address Postal Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Contact Phone Number *

Mobile preferred
Email *

Please use a non-school email address

Please carefully check your email address is correct as we will use this address for program communications.
2. Current and Previous Studies
Have you been accepted to or previously participated in the Year Summer Master Class or Year 12 University Preparation Program *

Have you been accepted to or previously participated in the Year Summer Master Class or Year 12 University Preparation Program Yes No
High School *
School Name *

Please answer the following questions: *
Please answer the following questions:	Yes	No
I am completing year 12 in 2020	I am completing year 12 in 2020Yes	I am completing year 12 in 2020No
I am completing a NSW HSC or International Baccalaureate pattern of study that makes me eligible to receive an ATAR in 2020	I am completing a NSW HSC or International Baccalaureate pattern of study that makes me eligible to receive an ATAR in 2020Yes	I am completing a NSW HSC or International Baccalaureate pattern of study that makes me eligible to receive an ATAR in 2020No

My NESA Student Number is *

This can be obtained from your school or found on your NAPLAN results.
I am currently completing the following subjects:

Please list your results for ALL subjects taken in year 11, even if you are not continuing these in year 12. Please also include any VET or TVET subjects.
Subject 1 *
Mark / Grade *
Subject 2 *
Subject 2, if other
Mark / Grade *
Subject 3 *
Subject 3, if other
Mark / Grade *
Subject 4 *
Subject 4, if other
Mark / Grade *
Subject 5 *
Subject 5, if other
Mark / Grade *
Optional Subject
Optional Subject, if other
Mark / Grade
Optional Subject
Optional Subject, if other
Mark / Grade
Please upload your completed Grade Verification Form here: *

Attach Files

Please ensure that files uploaded are in a PDF or JPG format.
3. Taking part in the UPP

In order to be eligible to participate in the program, you must be attending an In2Uni sponsored school OR meet one of the following criteria.
I am applying for the University Preparation Program based on the following entry criteria:

I am applying for the University Preparation Program based on the following entry criteria: I attend an in2uni school Completing the HSC in a rural or remote area* Identify as Aboriginal or Torres Strait Islander On a permanent humanitarian visa or have refugee status Currently experiencing financial hardship or disadvantage* Studies impacted by social disadvantage, disability or health condition*
* You may be asked to provide details of these circumstances following the close of applications. Please check with your school if you are unsure about whether you qualify under the rural or remote classification.
I am interested in studying/working in the following area/s at a post school level: *
Maximum of 200 characters allowed. Currently Entered: 0 characters.
Please list university degrees, TAFE or other RTO course details or the career you hope to enter post high school.
Please tell us in a few sentences why you want to take part in the University Preparation Program *
Maximum of 500 characters allowed. Currently Entered: 0 characters.
Please list two HSC subjects you think you would benefit most from receiving support in:

Please note UOW can not guarantee assistance in specific subjects.
Support Subject 1 *
Support Subject 2 *
Please indicate which UPP session you will be attending *

Please indicate which UPP session you will be attending Wollongong Campus: Wednesday, 1:30pm - 3:00pm Wollongong Campus: Wednesday, 4:00pm - 5:30pm Wollongong Campus: Thursday, 1:30pm - 3:00pm Five Islands Secondary College: Thursday, 3:45pm - 5:15pm South Western Sydney (Liverpool) Campus: Wednesday, 4:00pm - 5:30pm South Western Sydney (Liverpool) Campus: Thursday, 2:00pm - 3:30pm Southern Highlands Campus: Tuesday, 4:30pm - 6:00pm Batemans Bay Campus: Wednesday, 4:00pm - 5:30pm Batemans Bay Campus: Thursday, 4:00pm - 5:30pm Bega Campus: Tuesday, 4:00pm - 5:30pm Eden Marine High School: Thursday, 2:30pm - 3:30pm Shoalhaven Campus: Tuesday, 4:00pm - 5:30pm Shoalhaven Campus: Wednesday, 4:00pm - 5:30pm CUG Goulburn: Wednesday, 4:30 - 6:00pm
I understand that I must attend at least 80% of the scheduled in term face-to-face University Program sessions and am confident I can meet this commitment *

I understand that I must attend at least 80% of the scheduled in term face-to-face University Program sessions and am confident I can meet this commitment Yes
4. Parent Information & Consent
Parent's Name Parent's Name * First Last
Parent's Phone *
Parent's Email *
I authorise the above parent/guardian to receive information pertaining to my application, enrolment, and to make enquiries on my behalf

I authorise the above parent/guardian to receive information pertaining to my application, enrolment, and to make enquiries on my behalf Yes
I (the parent) have read, and agree to adhere to, the Terms and Conditions for the University Preparation Program as outlined on the website *

I (the parent) have read, and agree to adhere to, the Terms and Conditions for the University Preparation Program as outlined on the website Yes
I would like to receive information about Outreach and Pathways

I would like to receive information about Outreach and Pathways Yes
5. Medical and Emergency Contact Information
The parent listed above is my emergency contact *

The parent listed above is my emergency contact Yes No
Emergency Contact’s Name Emergency Contact’s Name * First Last
Emergency Contact’s Phone *
Relationship to Student *
Do you have any medical conditions or special needs requirements? *

Do you have any medical conditions or special needs requirements? Yes No
If yes, please specify *
Please upload medical plan *

Attach Files

PDF or JPEG file
I understand that by participating in this program my school may be advised of or discussions may be had with them in regards to my application, enrolment & ongoing participation in the UPP. *

I understand that by participating in this program my school may be advised of or discussions may be had with them in regards to my application, enrolment & ongoing participation in the UPP. Yes
I (the student) have read the Talent Release section on the Terms and Conditions, and hereby give my consent for In2Uni to use any images or videos of my appearance in any publications, websites or publicity material *

I (the student) have read the Talent Release section on the Terms and Conditions, and hereby give my consent for In2Uni to use any images or videos of my appearance in any publications, websites or publicity material Yes No
I (the student) have read, and agree to adhere to, the Terms and Conditions for the Year 12 University Preparation Program Class program as outlined on the In2Uni *

I (the student) have read, and agree to adhere to, the Terms and Conditions for the Year 12 University Preparation Program Class program as outlined on the In2Uni Yes

In2Uni Year 12 University Preparation Program 2020 Application Form

In2Uni Year 12 University Preparation Program 2020 Application Form

1. Personal Details

2. Current and Previous Studies

I am currently completing the following subjects:

3. Taking part in the UPP

Please list two HSC subjects you think you would benefit most from receiving support in:

4. Parent Information & Consent

5. Medical and Emergency Contact Information