Short Course Application Form

Title

Given Names (Value Required)

Chosen Name

Surname (Value Required)

Previous Surname

Date of Birth (Value Required)

Gender (Value Required)

Have you been a student at CDU before?

Do you have an overseas/international address?

Mobile phone

Work phone

Home phone

Email address (Value Required)

Home address (Value Required)

Suburb/Town (Value Required)

State (Value Required)

State/Region (Value Required)

Postcode (Value Required)

Country (Value Required)

Is your postal address different to your home address?

Postal address (Value Required)

Suburb/Town (Value Required)

State (Value Required)

State/Region (Value Required)

Postcode (Value Required)

Country (Value Required)

Location (Value Required)

Attendance mode (Value Required)

Starting from (Value Required)

ZSCM011 & ZSCM012
Please indicate your citizenship status	Australian Citizen New Zealand Citizen - residing in Australia for more than 6 months Permanent visa holder and those holding a visa without work/study restrictions Other - (you are not eligible to apply for this course)
Please confirm which intake you wish to apply for:	Term 3 (SEM-2) JUL-OCT Term 4 (INT-6) OCT-NOV
Will you be 18 years of age or over by the course commencement date?	No Yes

Q1. Are you of Aboriginal or Torres Strait Islander origin? (Value Required)

Yes

Q2. Is English your second language? (Value Required)

Yes

Q3. Do you have a disability, health condition or mental health condition? (Value Required)

Yes

Q4. What is your highest level of study? (Value Required)

Q5. How did you find out about Short Courses? (Value Required)

Personal Details