Preliminary Apply Form

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Course

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Course

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Campus

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Intake

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General Details

Title

Title is a required field

First Name

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Given name is a required field

Given name should not contain numbers or special characters

Last Name

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Surname is a required field

Surname should not contain numbers or special characters

Date of Birth

Date of Birth is a required field

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Which of the following best describes your Residency status?

Residency Information is a required field

Are you of Australian Aboriginal or Torres Strait Islander origin?

This is a required field

What brought you to our website?

This is a required field

Have you SUCCESSFULLY COMPLETED any qualifications?

Yes

Bachelor Degree or Higher Degree

Advance Diploma or Associate Degree

Diploma or Associate Diploma

Certificate IV or Advance Certificate

Certificate III

Certificate II

Certificate I

Certificates Other than Above

Contact and Residential Address Details

Unique Student Identifier

Provided USI number is not valid

* Invalid

Email is a required field

Email address is invalid or contains special characters

Confirm Email

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Email address does not match

Contact Number

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Search Residential Address

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Building Name

Unit/Flat Number

Street/Lot Number

Street/Lot Number is a required field

Street Name

Street is a required field

Suburb

e.g. BROADMEADOWS

Suburb is a required field

Please enter a valid suburb

State

e.g. VIC

Please enter a valid Australian State

Please enter a valid state

Postcode

e.g. 3047

Post code is a required field

Country

Country is a required field

Can not enter P.O. Box as residential address

Submit

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By submitting this form I agree that Bendigo Kangan Institute may use my personal information to contact me about products and services provided by Bendigo Kangan Institute and it’s partners. I understand that Bendigo Kangan Institute may profile and share my personal data with its agents for the purposes of marketing fulfilment. From time to time, Bendigo Kangan Institute may contact me by mail, telephone, email, other electronic messaging services (such as text, voice, sound or image messages including using automated calling systems) or fax with information about Bendigo Kangan Institute’s products and services. I understand that I can opt out of receiving this information at any time by writing to Bendigo Kangan Institute, Pearcedale Parade, Broadmeadows or by calling 138 233.

Preliminary Apply Form

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Course Application

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