Student Registration - Barossa Campus

Barossa Campus

A place for learning, collaboration and innovation.

Name*
First Middle Last
Preferred Name
Date Of Birth*
DD slash MM slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone*
Are you of Aboriginal or Torres Strait Islander Heritage?*
What is the highest level of education you have completed?
Has any member of your immediate family completed a university degree?
How did you hear about the Centre?
How far do you travel to access the Centre?
Do you have a disability?*
What language do you speak at home?*
- English
- Other
Please Specify
Emergency Contact*
Name
Phone*
Emergency Medical Information
Relevant information required in the case of an emergency
CHESSN
Student Identification Number*
Unique Student Identifier (USI)
Expected Graduation date
Tertiary Provider Name*
Provider Code*

Please type 'unsure' if details are unknown
Course Name*
Course Code*

Please type 'unsure' if details are unknown
Type of Study
Mode of Study
Level of Study
Year Level of Study
What best describes the support you would like from the Centre?
Select all that apply
- Enrollment help
- Space to Study
- Access to computer/printer/internet
- Mentorship/Cultural Support
- Academic skills
- Wellbeing support
- Collaborative learning enviroment
- Other
Please Specify
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

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