Personal · Web viewApplication Form: uni 2 beyond in 2022 Student Application Form A Please...

Application Form: uni 2 beyond in 2022Student Application Form A

Please complete this form to apply for a place in the uni 2 beyond (2022-2023).

You can ask someone to help you to fill out the form. Your application is due by 27th August 2021.

If you have questions or need help, please contact Diana at [email protected].

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mailto:[email protected]

We will contact you about your application by end of September 2021.

We will keep your information private.

Successful applicants are offered a placement for two years.

We are looking for students who:

Show interest in available subjects

Commit to university

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university

Make time for uni 2 beyond (for example, classes and social activities)

Are keen to learn and try new things

Can travel to university (with support if needed)

Have prior learning or work experience

Who can work with us to find the right balance of support

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1. Personal Information

Please fill out your personal information.

Name:

Date of Birth:

Address:

Home phone:

Mobile phone:

Email:

If you would like to include a support person, please fill out their details below:

Name:

Relationship to you:

Home phone:

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Mobile phone:

Email:

We will contact your support person in case of an emergency.

Do you identify as Aboriginal or Torres Strait Islander?

Yes No

Do you speak a language other than English at home?

Yes No

If YES, what language do you speak at home?

Did someone support you to fill out this form?

Yes No

If YES, who?

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2. About you

We have some questions about you.

Why do you want to join uni 2 beyond?

What do you want to learn and why?

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What are your interests and hobbies?

What are your strengths?

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What are you goals for the future?

How much time each week can you come to class and take part in uni 2 beyond activities?

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3. Study and work experience

List the high schools you went to:

Name of School Years attended

What type of school did you go to? Please tick all that apply

I went to a mainstream high school

I went to a special high school

I went to a specialist support class in a mainstream high school

Other: (Please specify)

Other Education Have you completed any other courses (for example, TAFE or other courses?

Please tick

Yes, I have completed other courses

No, I have not completed any other courses

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If you have completed other courses, please fill out this table with details:

Name of Course School/College Year completed

Work History

Have you ever had a job?

No, I have never had a job

Yes, I have a job now

Yes, I used to have a job

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Please tell us about your work history (paid or voluntary work), including the name of organisation and what you did

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4. Support needs

Tell us about your disability or disabilities.

Are you a person with an intellectual disability?

Yes No

Please tell us about your support needs.

Do you need support with:

No Yes (provide details)

Reading

Writing

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Speaking

Listening

Numeracy (maths, numbers)

Concentrating (for example, during in a class)

Using a computer – making documents (Word, PowerPoint)

Reading and writing emails

Video calls

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Using a mobile phone – texting and calls

Working in a team

Travel or using public transport

Moving around the university

Following instructions

Managing time (following a schedule)

Making friends

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Being organised

Being on time

Other:

Are you accessing specialist support? (for example, occupational therapy, behavioural support, speech therapy, physiotherapy, psychotherapy, counselling)

Your specialists can fill out the Application Form B.

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Do you need assistance from a support worker to come to university? Yes NoIf yes, what do they support you to do?

Is there anything else you want to tell us about you and joining uni 2 beyond?

5. DeclarationDeclaration Please tick

I confirm that all the information I have provided is correct Signature:

Date:

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