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Please complete this online enrolment form to facilitate efficent processing of your enrolment
Enrolment Form
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Applicant Details
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School / Organisation
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Course
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Invoice
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Title
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First Name
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Family Name
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Postal Address
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Number and Street
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Suburb or Town
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State
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Postcode
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Home Address (if different from above)
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Number and Street
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Suburb or Town
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State
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Postcode
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Home Phone Number
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Work Phone Number
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Mobile Phone Number
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Fax Number
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Email Address
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Gender
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Male
Female |
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Date of birth (DD/MM/YY)
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Country of birth:
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Disability
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| Do you consider yourself to have a disability, impairment or long-term condition? |
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| (If yes, please indicate the areas of disability, impairment or long term condition by ticking the applicable box(s):
Hearing / Deaf
Physical
Intellectual
Learning
Mental Illness
Acquired Brain Impairment
Vision - visual/sight/seeing
Medical Condition
Other - Please Specify |
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Prior Education
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Are you still attending secondary school?
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Yes
No |
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| Have you successfully completed any of the following School level / Qualifications? |
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School Level
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Completed year 12
Completed year 11
Completed year 10
Completed year 9
Completed year 8 or below
Did not go to high school |
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In which year did you complete that school level?
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Qualifications
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If YES, please indicate:
Bachelor Degree or Higher Degree
Advanced Diploma or Associate Degree
Diploma Level
Certificate IV
Certificate III
Certificate II
Certificate I
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Please list the certificate held
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Year of last qualification
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Language and Cultural Diversity
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Do you speak a language other than English at home?
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If yes, please specify the language at home spoken most often
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Please indicate how well you speak English.
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Are you of Aboriginal and/or Torres Strait Islander Origin?
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No, Neither Aboriginal nor Torres Strait Islander
Yes, I am Aboriginal
Yes, I am a Torres Strait Islander
Yes, I am Aboriginal and a Torres Strait Islander |
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Emergency Contact Details
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Name
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Relationship
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Contact Number
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Employment
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Which best describes your current employment status (Select applicable box(s)):
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Full time employee
Part time employee
Self Employed - Not employing others
Employer
Unemployed - Seeking full time work
Unemployed - Seeking part time work
Not Employed - Not seeking employment
Employed - Unpaid worker in family business
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Reason For Study
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Which best describes your main reasons for undertaking this course.
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To get a job
Extra skills for my job
To get a better job or promotion
Start my own business
Requirement of my job
Try for a different career
Develop my own business
Get into another course of study
Personal Interest / self development
Other |
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Privacy:
No information about your enrolment will be divulged to an external body or other person without your written authority. The exceptions to this are where we are legally obliged to provide it (ie. National Student Outcomes Survey). All information retained is subject to the regulations of the Privacy Act 1988. Please refer to the Privacy Statement below.
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Date
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