Uni Connect

Uni Connect

• Name

  Name * First Last
• Gender *
  Male Female Transgender Other Prefer not to answer
• Date of birth

  Date of birth * / DD / MM YYYY

  
• I identify as Aboriginal and/or Torres Strait Islander *
  Yes No I prefer not to answer
• Has anyone in your immediate family attended University? *
  Has anyone in your immediate family attended University?

  Yes No
• Contact Phone Number *
• Personal Email *
• Current School Year *
  Year 11 Year 12
• High School Name *
• What subjects are you studying in your HSC *
• Do you have access to a computer device with web cam (laptop, tablet, desktop) from home? *
  Do you have access to a computer device with web cam (laptop, tablet, desktop) from home?

  Yes No
• Do you have access to the internet from home? *
  Do you have access to the internet from home?

  Yes No
• Tell us about your current ideas of what you are thinking of doing after your HSC *
• Please list some of your interests/hobbies/passions *
• Please tell us below what UniConnect timeslot best suits you to complete the consultation (note: the consultations are done in a group setting monthly) *
  Mondays 4pm - 4:30pm Mondays 4:45pm - 5:15pm Tuesdays 4pm - 4:30pm Tuesdays 4:45pm - 5:15pm

• Parent Information

• 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 and to make enquiries on my behalf *
  I authorise the above parent/guardian to receive information pertaining to my application and to make enquiries on my behalf

  Yes No

• 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 Name

  Emergency Contact Name * First Last
• Emergency Contact Email *
• Do you have any medical conditions or special needs requirements? *
  Do you have any medical conditions or special needs requirements?

  Yes No
• Please specify medical conditions or special needs requirements *

• Agreement & Consent

• I as the student *
  I as the student

  have read, and agree to adhere to, the Terms and Conditions for Uni Connect. 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 and participation in UniConnect. 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.