Enrolment Form:

Course Title:

Course Dates:

Title:

Gender:

NB: Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names

First Name:

Middle:

Surname

Mobile:

Email:

Birthday

Day

Month

Year

Phone

Address

Company name

Position

Address

Email

USI

In which country were you born?

Do you speak English?

Very well

I get by

Not well

Not at all

Are you Aboriginal or Torres Strait Islander origin?

No

Yes, Aboriginal

Yes, Torres strait islander

Do you consider yourself to have a disability, impairment or long-term condition?

Yes

No

Are you still enrolled in secondary or senior education?

Yes

No

Have you successfully completed any previous qualifications?

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or associate diploma)

Certificate IV (or Advanced Certificate/ Technician)

Certificate III

Certificate II

Certificate I

Certificates (inc overseas qualifications) not listed above

Which describes your current employment? (tick only 1 box)

Full time employee

Part time employee

Self- employed - not employing others

Self-employed - employing others

Employed - unpaid worker in a family business

Unemployed - seeking full time work

Unemployed - seeking part time work

Not employed - not seeking employment

Will you be applying for recognition of existing skills for any or all of your course?

Yes

No

I have read & understand the course information & student handbook?

Yes

No