First name and last name (as it appears on your ID documents)

Middle name

Preferred name

Date of birth

Day

Month

Year

Email address (Please provide your personal email address, not an email address from your university or school).

Has your permanent place of residence changed since you submitted your application to Women’s?

Yes

No

What is your new address for your permanent place of residence?

Address 1

Address 2

City

ZIP / Postal Code

State / Province

Country

The Women’s College will send communications and invitations to events to the Parent/Guardian whose details you provide below. If you would like two Parent/Guardians to receive communications and event invitations, please ensure you provide details for both family members.

Parent/Guardian 1

First Name

Last Name

Parent/Guardian Email

Is Parent/Guardian 1 an alumna of The Women’s College?

Yes

No

When did Parent/Guardian 1 reside at The Women’s College?

Would you like to add details for a second Parent/Guardian?

Yes

No

Parent/Guardian 2

First Name

Last Name

Parent/Guardian 2 Email

Is Parent/Guardian 2 an alumna of The Women’s College?

Yes

No

When did Parent/Guardian 2 reside at The Women’s College?

In case of an emergency, who would you like the College to contact? If you select Parent/Guardian 2, make sure you have provided their details in the previous section of this form.

Alternate Emergency Contact

First Name

Last Name

Emergency contact’s email address

Emergency contact’s mobile number

Emergency contact’s secondary phone number (if available)

All information provided in this section will be treated confidentially and with sensitivity. We will work with you to support you if you are encountering or recovering from any medical or wellbeing issues.

Heart or blood pressure conditions – please provide details including history and current medication (if applicable).

Diabetes – please provide details including history and current medication (if applicable).

Epilepsy – please provide details including history and current medication (if applicable).

If you have an action plan, please email a copy to admissions@womens.uq.edu.au

Anaphylaxis – please provide details including triggers, history, and current medication (if applicable). If you have an action plan, please email a copy to admissions@womens.uq.edu.au

Asthma or any other respiratory conditions – please provide details including history and current medication (if applicable). If you have an action plan, please email a copy to admissions@womens.uq.edu.au

Food allergies – please provide details including specific allergens, history and current medication (if applicable).

Dietary requirements – please provide details.

Other allergies – please provide details including specific allergens, history and current medication (if applicable).

Learning conditions – please provide details including history and current medication (if applicable).

Mental health – please provide details including history and current medication (if applicable).

Eating disorders – please provide details including history and current medication (if applicable).

Sleep conditions – please provide details including history and current medication (if applicable).

Other medical or wellbeing conditions – please provide details including history and current medication (if applicable).

Accessibility and Welfare or Disability Support Service – please provide details.

What happens after this form is submitted? A message appears for the user saying: Thank you for providing your details. Your information will be treated as confidential. If you need to disclose or discuss any further information, please contact the College at admissions@womens.uq.edu.au A notification that this form has been submitted is sent to admissions@womens.uq.edu.au.

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Additional Information Form

The Women’s College will send communications and invitations to events to the Parent/Guardian whose details you provide below. If you would like two Parent/Guardians to receive communications and event invitations, please ensure you provide details for both family members.

In case of an emergency, who would you like the College to contact? If you select Parent/Guardian 2, make sure you have provided their details in the previous section of this form.

All information provided in this section will be treated confidentially and with sensitivity. We will work with you to support you if you are encountering or recovering from any medical or wellbeing issues.