Graduate Entry Registration Form Please complete all sections accurately before submitting. Full Name (Surname, First) Date of Birth (dd/mm/yyyy) Gender FemaleMaleOther Email Address Phone / WhatsApp Province —Please choose an option—CentralEastern HighlandsEngaGulfHelaJiwakaMadangManusMilne BayMorobeNCD (Port Moresby)OroSouthern HighlandsWest New BritainEast New BritainWestern (Fly)Western HighlandsEast SepikWest Sepik (Sandaun)Autonomous Region of Bougainville District Highest Education Level —Please choose an option—Grade 10Grade 12CertificateDiplomaBachelorMastersPhDOther Year Completed —Please choose an option—1970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030 Course Applying For —Please choose an option—BSBWHS30719 Certificate I–III in WHSBSBWHS41419 Certificate IV in WHSBSBWHS51319 Diploma of WHS Training Dates —Please choose an option—15 June 2026 - 26 Jun 2026 – Certificate I–III in WHS14 Sept–26 Sept 2026 – Certificate IV in WHS14 Sept–26 Sept 2026 – Diploma of WHS Course Duration Preferred Mode of Study Face-to-FaceOnlineBlended Reason for Chosen Mode
