AccessAbility - Prospective Students

* indicates a required field

AccessAbility Enquiry

NOTICE TO CURRENT SWINBURNE STUDENTS

This enquiry form is for future students only.

Log into the Student Access Portal to contact us.

Are you a currently enrolled student at Swinburne University of Technology?Required *

Are you a currently enrolled student at Swinburne University of Technology? Yes Are you a currently enrolled student at Swinburne University of Technology? No

STUDENT INFORMATION

First NameRequired *

Preferred Name

Last NameRequired *

Preferred pronouns

Gender

Please specify

EmailRequired *

Phone NumberRequired *

Date of BirthRequired *

Button, Start Date - Pick Using Date Picker Widget Button, Start Date - Clear/Reset Selected Date

Are you currently attending secondary school?

Are you currently attending secondary school? Yes Are you currently attending secondary school? No

Name of Secondary School

What level of study are you considering?

What course or course area are you interested in studying?

e.g. Business, Science, Community Services

Are you an international or domestic student?Required *

Are you an international or domestic student? International Are you an international or domestic student? Domestic

What is your Studylink application email address?

Would you to like to provide an Authorised contact?

If you would like AccessAbility Services to include another person in communications about your study support needs, please provide us with their details. Should you wish to withdraw consent at any time, or you would like to update these details, please inform AccessAbility Services as soon as possible via accessability@swin.edu.au

Would you to like to provide an Authorised contact? Yes Would you to like to provide an Authorised contact? No

Authorised Contact Full Name

Authorised Contact Relationship

Authorised Contact Number

Authorised Contact Email Address

My diagnosed disability falls into the following category

Have you had supports or adjustments that have worked for you before in school or another environment?

If yes, please list them.

Upload supporting documents (Optional)

Please attach a completed Health Practitioner's Report, or other letter/report from your health practitioner as part of your registration.

STUDENT AUTHORISATION AND CONSENT

By submitting this form and any supporting documentation, you are providing Swinburne AccessAbility Services written authority to obtain and release information relevant to your study support needs. Information provided to AccessAbility Services is treated as confidential and collected in accordance with Swinburne’s Privacy policy, guidelines and procedures. You can learn more at swinburne.edu.au/privacy/

I agree to all of the above *

AccessAbility - Prospective Students

AccessAbility Enquiry

Document Information