Note: All fields marked by an * must be completed.

Personal Details

First name

Last name

USQ student number

Current students only

Date of birth

Gender

MaleFemale

Please provide the following information

Academic program

i.e. Bachelor of Arts

Study load

Full timePart time

Postal address

City

State

Postal code

Country

Mobile phone

Home phone

Fax

Sport

Sport contact person

coach, manager etc

Contact's phone

Sports scholarship

AISState Institute of SportNone

What is the highest level of competition you have competed at and when?

What is the highest level of competition you hope to compete at and when?

Outline your typical training week

Do you anticipate being absent for a significant period of time during the academic year due to any competitions or training camps? When?

Supporting Documentation

If you have any supporting documentation that you would like to attach to your registration, please add them below.

Attachment 1

Attachment 2

Attachment 3

USQ is collecting the personal information on this Form for university purposes pertaining to the Elite Athlete Program. USQ usually gives some or all of this information to sections of the University managing the Elite Athlete Program. Your personal information will not be disclosed to any other third party without your consent unless required or authorised to do so by law.

Additional privacy information is available online.

Study

About USQ

Contacts

Research

Industry

Acknowledgement of First Peoples