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Nature of Enquiry
I would like to register for the first time
I would like to update my details
Personal Information
Title:
First Name:
Middle Name(s):
Last Name:
Preferred Name:
Contact Information
Email Address:
Telephone Number:
Mobile Phone Number:
Street Number and Name:
Suburb:
State:
Postcode:
Country:
Further Information
Date of Birth
(dd/mm/yyyy)
:
This information is used to uniquely identify you.
Gender:
Male
Female
Former Name(s)
(if applicable)
:
I am a former staff member
Staff Number:
I am a current staff member
Staff Number:
Study Information
I am a current student
Student Number:
I am a former student
Student Number:
Student Name
-
copy name
details entered above:
First Name:
Middle Name(s):
Last Name:
Preferred Name:
Degree
Year(s) of Study
Year Completed
School/Faculty
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Please use the Other Information box, below, to add further information if necessary.
Employment Details
Industry:
Organisation:
Position:
Other Information
Interests, additional comments or questions:
Privacy Assurance Information
The University of Queensland is collecting information on this form to allow us to provide you with relevant information about University services, events and achievements. The information you supply will only be used for University purposes. The University of Queensland will not disclose your personal information to any third parties except in accordance with its privacy management policy. Please refer to The University of Queensland's
Privacy Statement
and
Privacy Management Policy
for further information.
