Course Reinstatement Form - International Students Required fields are marked with an asterisk (*). Personal DetailsStudent ID Family Name * Given Names/First Names * Date of Birth * Day 12345678910111213141516171819202122232425262728293031 Month JanFebMarAprMayJunJulAugSepOctNovDec Year 19001901190219031904190519061907190819091910191119121913191419151916191719181919192019211922192319241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024202520262027202820292030203120322033203420352036203720382039204020412042204320442045204620472048204920502051205220532054205520562057205820592060206120622063206420652066206720682069207020712072207320742075207620772078207920802081208220832084208520862087208820892090209120922093209420952096209720982099 Course Name * Course Code * Personal Contact Details Mailing Address Address Line 1 * Address Line 2 Town/Suburb * State * -- Please Select --ACTNSWNTQLDTASVICWA Postcode * Please enter your postcode in 4 digit format (No spaces, no characters) Telephone Number * (2 Digit Area Code + 8 Digit Number) Email * Residential Address Preference Is your Residential Address the same as your Mailing Address? * -- Please Select --YesNo Residential Address Address Line 1 * Address Line 2 Town/Suburb * State -- Please Select --ACTNSWNTQLDTASVICWA Postcode * Please enter your postcode in 4 digit format (No spaces, no characters) Acceptance I have read and accept the Privacy Statement and Declaration * Yes