MPC Application

Please tick the appropriate boxes: *

CUA20215 - Certificate II in Creative Industries (Film and Design) CUA20215 - Certificate II in Creative Industries (Interactive) CUA31015 - Certificate III in Screen and Media (Film and Design) CUA41215 - Certificate IV in Screen and Media CUA40715 - Certificate IV in Design CUA20615 - Certificate II in Music Industry (Song Writing and Performance) CUA30915 - Certificate III in Music Industry (Song Writing and Performance) CUA40915 - Certificate IV in Music Industry (Song Writing and Performance) CUA20615 - Certificate II in Music Industry (Sound Production) CUA30915 - Certificate III in Music Industry (Sound Production) CUA40915 - Certificate IV in Music Industry (Sound Production) 10432NAT - Certificate III in Christian Ministry and Theology 10433NAT - Certificate IV in Christian Ministry and Theology

Unique Student Identifier (USI) *

What is a USI?

USI Authorisation *

Please tick this box to authorise MPC to verify your USI

Title *

Mr Mrs Ms Miss

Family Name *

Given Names *

Preferred First Name *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email *

Birth Date *

Month Day Year

Phone (Home or Mobile) *

Where did you hear about Mount Pleasant College? *

Current School Name

Year Level

- OR - Highest Education Standard Attained

Emergency Contact Name *

Relationship to Applicant *

Emergency Contact Email Address *

Emergency Contact Phone Number 1 *

Emergency Contact Phone Number 2

Contact for all invoicing / payment correspondence *

School Parent/Guardian Student

Contact Name *

Contact Phone *

Contact Email *

I will be applying for Youth Allowance / Austudy / Abstudy *

Yes (only applicable for full time students) No

I will be submitting a separate application for Recognition of Prior Learning (RPL) *

Yes No

I am a returning student *

Yes No

Medical Info

Please list any significant illnesses, conditions or allergies

Please list any medications you are taking

Administering Medication

I can self-medicate I need assistance

Mount Pleasant College is required to hold written authorization from Parents/Guardians of students who are under 18 years of age before administering Paracetamol, Ibuprofen, and Hay Fever medication. An email will be forwarded on each occasion, advising parents/guardians of the medication issued.

I/We authorize Mount Pleasant College to issue small amounts of these medications to my child.

Medical Emergency Procedure

Please list any other emergency contacts other than the one already listed earlier.

Emergency Contact Name

Contact Phone

Emergency Contact Name

Contact Phone

In the event of an emergency, I/we authorize MPC to secure an Ambulance and/or medical attention for my child.

Consent for Photographs *

I agree to give permission for any film or photographs taken within the college environment or activities; to be used for college publication. I acknowledge that this may include promotion for the college in print, screen and/or web format. (Please contact MPC Administration if this is an issue.)

Consent for Travel (parents/guardians to complete if student is under 18 years of age)

I give permission for student to travel accompanied/driven by their Supervisor/Instructor as part of course tasks.

Please indicate how student will travel to MPC

Please indicate how student will travel after classes

Meal breaks: Is student permitted to leave the College premises for meal breaks?

Yes No

Application Fee ($100) payable now *

Credit Card Bank Transfer

*Please note that this fee is
separate from the tuition fees.

Secure Credit Card payment: *

MPC Application Fee $ 100.00 AUD

Total $ 0.00 AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year

Bank Transfer:
This transfer information will be emailed to you upon application submission. Transfer the application fee ($100) at your earliest convenience. MPC will follow up on the payment shortly.

Account: Mount Pleasant College
BSB: 066-163 (Commonwealth Bank)
Acc No.: 10367831
Amount: $100
Reference: Please identify with your surname + "MPCAPP"

Application Form