Personal Details Form Step 1 of 4 0% Personal DetailsTitle*MrMrsMsMxMissFirst Name*Last Name*Preferred Name*Gender*MaleFemaleNon-binaryNot SpecifiedDate of Birth*Email* We will use this email address as your primary contact point with AVCAT.Mobile Phone*Home Phone*Semester Mailing Address *(Semester Mailing Address) Address Line 1*Street Address *(Semester Mailing Address)Suburb*Suburb*(Semester Mailing Address) State*State* Please SelectACTNSWVICNTSATASWAQLD(Semester Mailing Address) Postcode*Postcode*Is your home address the same as your semester address?*YesNoHome Address *(Home Address) Address Line 1*Street Address *(Home Address) Home Suburb*Home Suburb*(Home Address) Home State*Home State* Please SelectACTNSWVICNTSATASWAQLD(Home Address) Postcode*Postcode*Bank Account Details **Bank Account Name *Bank Name*Bank Name *BSB Number*BSB Number **Bank Account Number *Secondary Contact Details **Relationship to Student * Please SelectFriendGrandparentGuardianParentPartnerSiblingStep Parent(Secondary Contact) First Name*First Name*(Secondary Contact) Last Name*Last Name*(Secondary Contact) Mobile Number*Mobile Number*(Secondary Contact) Phone NumberPhone Number*Email* If you would like to authorise this person to act on your behalf, please tick the box below: Secondary contact permitted to act on my behalf If you would like to give another person permission to act or enquire on your behalf, please contact AVCAT directly. Save and Continue Later Study and Payment DetailsOn what basis are you enrolled?*SemesterTrimesterWhat is your current course?*e.g. Bachelor of Arts.What is your current level of study?*Please SelectCertificate 1Certificate 2Certificate 3Certificate 4DiplomaAdvanced Diploma or Associates DegreeBachelors DegreeHonours DegreeGraduate Certificate/DiplomaMasters DegreeDoctoral DegreePlease select your current institution*Please SelectAustralian Catholic UniversityAustralian National UniversityBond UniversityCentral Queensland UniversityCharles Darwin UniversityCharles Sturt UniversityCurtin UniversityDeakin UniversityEdith Cowan UniversityFederation UniversityFlinders UniversityGriffith UniversityJames Cook UniversityLa Trobe UniversityMacquarie UniversityMonash UniversityMurdoch UniversityQueensland University of TechnologyRMIT UniversitySouthern Cross UniversitySwinburne University of TechnologyTAFE ACTTAFE NSWTAFE NTTAFE QLDTAFE SATAFE TASTAFE VICTAFE WATorrens UniversityUniversity of AdelaideUniversity of CanberraUniversity of DivinityUniversity of MelbourneUniversity of New EnglandUniversity of New South WalesUniversity of NewcastleUniversity of Notre DameUniversity of QueenslandUniversity of South AustraliaUniversity of Southern QueenslandUniversity of SydneyUniversity of TasmaniaUniversity of Technology SydneyUniversity of the Sunshine CoastUniversity of Western AustraliaUniversity of WollongongVictoria UniversityWestern Sydney UniversityOtherWhat is your current year of study?*Please Select1st2nd3rd4th5th6thWhat is your current completion date?*Choose the date that is closest to your completion date.Please Select2020 June2020 December2021 June2021 December2022 June2022 December2023 June2023 December2024 June2024 December2025 June2025 DecemberAre you enrolled concurrently at another institution?*YesNoPlease give details about your concurrent enrolment at another institution.*Please Note: You will need to upload a Enrollment Certificate from your nominated institution at the end of this form.Educational Payment Details *Which educational payment do you receive?*Please SelectYouth AllowanceVCESNewstartAbstudyAustudyCarers PaymentDisability PensionOtherPlease Note: You will need to upload a letter from Centrelink or The Department of Veteran’s Affairs (VCES) confirming your payment in the Supporting Documentation section. Save and Continue Later Upload SectionPlease Note: We must be able to see your name printed as part of any documentation uploaded. This is to confirm your ownership of the document.Proof of government means-tested educational payment*For example, this could be a current letter from Centerlink detailing your payment. If unavailable, a recent copy of your bank statement identifying a Centrelink or DVA payment is acceptable (your name must be clearly printed on the statement).Enrollment Certificate for the next six-month period*This certificate is available at no cost through your Student Services Department or online through your student portal. Please note that course acceptance letters, timetables and student cards are not accepted.Headshot*Please upload a picture of yourself for AVCAT's records.Signed Acceptance Letter*Your letter of offer has been emailed to you by AVCAT. You will need to sign and upload this letter here. Save and Continue Later Recipient StatementI,* - certify that the information given in this document is correct to the best of my knowledge - undertake that, if I am continuing with my scholarship, to disclose to AVCAT within 30 days of any further changes to my full-time enrolment status, course plans, financial or other relevant circumstances and contact details - authorise AVCAT to make whatever enquiries it deems necessary with educational authorities, government agencies or others, to determine the continuing eligibility for a scholarship - acknowledge that, if I receive payments to which I am not entitled, these are to be repaid to AVCAT within 10 days. If I fail to respond to AVCAT’s requests for information it requires to administer my scholarship, or knowingly provide misleading information, my scholarship may be terminated. Signature*Date*Day12345678910111213141516171819202122232425262728293031Month123456789101112Year202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Are you human?CommentsThis field is for validation purposes and should be left unchanged. Save and Continue Later This iframe contains the logic required to handle Ajax powered Gravity Forms.