Please fill in the below information as follows so that the information requested can be forwarded on accordingly.

Given Name: Family Name:

Residential Address:

Postal Address: (Put as above if the same a residential Address.)

Phone:

Fax:

Email:

Are you currently Enrolled at South bank: Yes No

Student Number: (Only if your are Enrolled at South bank)

If you have previously inquired or know the course name you would like more information into please fill in the section below.

Course Name:
Additional Course Name/s:

As to try and attain the appropriate information in regards to your request please fill out the below with as much detail as possible.

Field/s of Interest:
(Please select the field/s of interest.)

Cert2: Cert3: Cert4: Diploma:

Please fill out some key interests and a brief description of elements your looking for in your tertiary course.

Description:

Would you like to be kept up to-date with course made available at South bank:

(please tick how you would like to receive updates.)

via Post: via Email: via Fax:

Would you like to subscribe to South bank's monthly Newsletter:

(please tick how you would like to receive Newsletter.)

via Post: via Email:

Disclaimer

All information acquired by south bank will not be use or stored after the request as been processed.

The information or details will not be given out too any body corporate or other organisation, all details gain through this process will be destroyed and disposed of after said process is completed.

For further information please contact the South Bank Institute of Technology via phone or view our policies found upon the South Bank website.