test-form – Australian Data and Cyber Institute

ADCI Student Application Consent Form

Do you hold a current Australian Temporary entry permit or visa?

Yes

VISA Type

VISA Grant Number

What is the name of the course you are currently enrolled in?

Do you have an Australian Government USI (Unique Student Identifier)?

Yes

VISA Expiry Date

Are you currently studying in Australia?

Yes

What is the name of your current education provider:

Have you, or your spouse or any dependents ever been refused a visa to Australia?

Yes

Have you, or your spouse or any dependents ever visited Australia and breached any visa conditions?

Yes

ADCI PRIVACY NOTICE AND CONSENT (Please tick all boxes)

The information collected in this form is required to facilitate your enrolment and will be handled and stored in line with ADCI's Privacy and Personal Information Procedures. ADCI reserves the right to verify any of the details you have provided on this form in order to assess your application. Some information requested on this form is collected to comply with the reporting requirements of the Higher Education Support Act 2003 and will be disclosed to the Commonwealth Department responsible for the administration of the Act as well as other information regarding your studies with the Institute. If you access Commonwealth Assistance while enrolled with ADCI, information about you and the study you undertake will be provided to the Australian Taxation Office.

I confirm that I am 18 years of age or older and consent to ADCI in connection with and for the purposes of my application and study

collecting, storing, using, transferring, disclosing and otherwise handling my personal information (including sensitive information)

providing my personal information to any other data controllers or data processors for processing my personal information (indlucing
sensitive information)

disclosing my personal information (including sensitive information) to relevant authorities or required by applicable laws and
regulations

I have read, understood and agree to be bound by the terms and conditions of enrolment detailed in the enrolment information and
policies available online at www.adci.edu.au.

I declare that the information I have submitted is a true and complete record of all academic results I have received.

I declare that I have read the instructions on this application form and that, to be best of my knowledge, the information provided by me
is true and complete in every way

I acknowledge that ADCI may vary or reverse any decision regarding admission or enrolment made on the basis of incorrect or incomplete
information provided by me.

I give permission to ADCI to verify or obtain records from other educational institutions that I have attended.

I have read and agree to the Privacy Policy

Apply through Agent?

Yes

Company Name

Agent Email

Agent Contact Number

First Name

Last Name

Your Email

Date

I consent to have this website store my submitted information so they can respond to my inquiry

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ADCI PRIVACY NOTICE AND CONSENT (Please tick all boxes)

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