University of Southern Queensland Graduations Office

2016 Graduation Ceremony Response

Return this form by the registration date for your ceremony to:
USQ Graduations Office
University of Southern Queensland
West Street
Toowoomba QLD 4350
Phone: +61 7 4631 1647 or +61 7 4631 1741
Email: graduations@usq.edu.au
USQ is collecting the personal information on this form for university purposes including to coordinate its Graduation Ceremonies and related
activities such as publication of the official graduation program, awarding of testamurs and prizes, ceremony attendance registration, gowning
services and promotional activities. This information is recorded within the Universitys data management system and managed by the
Graduations Office.
Some or all of your personal information may also be disclosed to third parties but only when it relates to a graduation ceremony or an event
arising out of and in connection with your graduation. Third Parties can include:

Media, including The Toowoomba Chronicle and Fraser Coast Chronicle or other reputable news publishers who may publish a complete
list of names and awards for each USQ graduation ceremony and other promotional materials or communications.

The Public throughout the World through publications, on-line and in print, including USQs official graduation programs and at some
ceremonies, USQ films the ceremony and uploads it to the web and makes DVDs available for purchase (if this service is important to
you, please check availability on-line for your relevant ceremony).
Your personal information will not be disclosed to any other third party other than as set out above without your consent unless required or
authorised to do so by law. Your rights to access and amend your personal information are set out in the Information Privacy Act 2009 (Qld)
which also places obligations on USQ as to how we handle your personal information. For further information concerning Privacy, please direct
any queries to the USQ Privacy Officer privacy@usq.edu.au
By submitting this form you agree and irrevocably consent to the uses and disclosures including the publications and transfers outside of
Australia of your personal information as outlined above. If you do not consent to the above, please register your concerns or queries at
graduations@usq.edu.au.

STUDENT DETAILS
Student Number:

00161062977

Name of
program:

master of information system

Date of Birth: 15 oct 1990

HAVE YOU CHANGED YOUR NAME?

If you want to graduate under a name different to that on your student records or official USQ statements you are required to
provide proof of your legal name (eg Change of Name Certificate, Birth Certificate, Passport, Australian Drivers Licence or
Marriage/Divorce Certificate). Copies of documents will not be accepted unless a Justice of the Peace has certified them. If this
Form is submitted with a change of name indicated, but without supporting documentary evidence, changes will not be
processed or recognised.

Family Name:

Mohammed

First and Second

Names:

Talaha mohiuddin

Address:

4/11

City: sydney

State: nsw

Mobile Phone:

0470269581

Email:

talahachamp@gmail.com

Postcode: 2135

Country: australia

GRADUATION CEREMONY OPTIONS Check one option only

I will not be attending a ceremony and authorise my testamur to be mailed to the address listed or, if I am aligned to a
USQ partner it will be posted to the USQ-registered partner address.

Toowoomba Disciplines: Business & Commerce; Information Technology;

Law & Justice*
Friday, 1 April 2016
10:00am
Clive Berghofer Recreation Centre, Toowoomba

Enter Guest Number

Limit of 6 including
yourself

Registration Due: 10 March 2016

Ceremony Fee Due: 17 March 2016

Toowoomba Disciplines: Creative Arts & Media; Engineering & Built

Environment; Humanities & Communication *
Friday, 1 April 2016
2:00pm
Clive Berghofer Recreation Centre, Toowoomba

Enter Guest Number

Limit of 6 including
yourself

Registration Due: 10 March 2016

Ceremony Fee Due: 17 March 2016

Toowoomba Disciplines: Sciences; Health & Communities*

Friday, 8 April 2016
10:00am
Clive Berghofer Recreation Centre, Toowoomba

Registration Due: 17 March 2016

Ceremony Fee Due: 24 March 2016

Enter Guest Number

Limit of 6 including
yourself

Toowoomba Discipline: Education*

Enter Guest Number

Friday, 8 April 2016

2:00pm
Clive Berghofer Recreation Centre, Toowoomba

Limit of 6 including
yourself

Registration Due: 17 March 2016

Ceremony Fee Due: 24 March 2016

Fraser Coast all Disciplines

Enter Guest Number

Friday, 29 April 2016

11:00am
Brolga Theatre, Maryborough

Registration Due: 7 April 2016

Ceremony Fee Due: 14 April 2016

Springfield all Disciplines

Limit of 6 including
yourself

Enter Guest Number

Limit of 4 including
yourself

Friday, 6 May 2016

11:00am
Ipswich Civic Centre, Ipswich

(Only students who have studied on-campus at USQ Springfield may attend this ceremony)

Registration Due: 14 April 2016

Ceremony Fee Due: 21 April 2016

Sydney all Disciplines

Enter Guest Number

Tuesday, 24 May 2016 6:30pm

Doltone House, Jones Bay Wharf, Piers 19-21, Upper Deck, 26-32 Pirrama Rd, Pyrmont, Sydney
Additional guest tickets can be purchased for AUD40.00 each no later than 28 April from USQ
Finance.
No tickets are available for sale after this date.
No tickets are available for sale on the day of the ceremony.
Access to the graduation ceremony is by ticket only.
NB: No refunds are available on purchased tickets.
Registration Due: 28 April 2016
Ceremony Fee Due: 9 May 2016

+ any extra purchased

guest tickets at AUD40
per head

Kuala Lumpur, Malaysia all Disciplines

Enter Guest Number

Sunday, 29 May 2016

2:00pm
Hilton Kuala Lumpur (Grand Ballroom Level 6), 3 Jalan Stesen Sentral, 50470 Kuala Lumpur,
Malaysia.
Additional guest tickets can be purchased for AUD45.00 each no later than 5 May from USQ
Finance.
No tickets are available for sale after this date.
No tickets are available for sale on the day of the ceremony.
Access to the graduation ceremony is by ticket only.
NB: No refunds are available on purchased tickets.
Registration Due: 5 May 2016
Ceremony Fee Due: 12 May 2016

Limit of 3 including
yourself

Limit of 3 including
yourself

+ any extra purchased

guest tickets at AUD45
per head

ACADEMIC DRESS MEASUREMENTS KUALA LUMPUR, SPRINGFIELD, FRASER COAST, SYDNEY

Your height (cm)
(Size 110)

153cm+

Head circumference (cm)

NB: At all Toowoomba graduations academic dress will

be sized and fitted on the day of the ceremony no
need to supply measurements.

Ceremony Fee:
The Ceremony Fee to attend a USQ graduation ceremony is AUD100.00.
This fee includes: Hire of academic dress; some guest seats; refreshments; graduation program.
Payment of AUD100.00 can be made to USQ Finance on +61 7 4631 2583 or via email to usqdebt@usq.edu.au.
Payment is due by the due date for the ceremony for which you register. No invoice will be issued.

* Please contact the Graduations Office if you are unsure which Discipline your Program falls under and which
Graduation Ceremony you should attend.
(CRICOS No: 00244B QLD; 02225M NSW; TEQSA PRV12081)