Application Form

Personal Information

Preferred Name
Date of Birth(Required)
Citizenship Status(Required)

Is English your first language?(Required)
Do you identify as Aboriginal and/or Torres Strait Islander?(Required)
Do you have a disability, impairment or long term medical condition which may impact your learning experience?(Required)
*if YES, we may be in contact to discuss support services and facilities which may assist you.
If under 18 at time of completion name of parent/carer
Details of Emergency Contact


a reference check form will be directed to them
a reference check form will be directed to them
How long have you attended this church?(Required)


Highest level of education acheived(Required)

That you will have completed at the end of 2023
If you do not have an ATAR please either type NONE or indicate the type of score and your result (eg IB score, A levels score etc)



Which IMPACT format are you applying for?(Required)
Would you like more info to apply for:(Required)
Please click any option that applies to you
By clicking this box I am submitting the information in this form to the IMPACT team to review. The next stage in this process will involve a personal interview and contact with your church references as listed above. You can expect contact from the IMPACT team in the next 2 weeks to arrange next steps. If you have further questions please contact the IMPACT Gap year team via email.