Course Enrollment Course Code Course Name Credit Transfer Credit Transfer Yes No Recognition of prior learning Recognition of prior learning Yes No Student Details Surname Given Name/s Title Title MR MRS MS MISS Date Of Birth Mobile Email Do you have a disability? Do you have a disability? Yes No Please Specify Please tell us which photo ID you can present Please tell us which photo ID you can present Drivers Licence Passport Other Were you born in Australia? Were you born in Australia? Yes No If no, what is your residence status If no, what is your residence status Permanent Temporary Visitor Country Of Birth Town Of Birth Are you of Aboriginal or Torres Strait Islander Origin? Are you of Aboriginal or Torres Strait Islander Origin? Aboriginal Torres Strait Islander No Do you speak a language other than English at home? Do you speak a language other than English at home? Yes No If yes, please specify Still attending secondary school? Still attending secondary school? Yes No If yes, please specify If yes, please specify YR 8 YR 9 YR 10 YR 11 YR 12 Address (Please ensure you advice Licence Me of any change of address details) What is your address? Please include the full address e.g. 120 McDowall Street Albury NSW 2640 What is your billing address (If different from above)? Please include the full address e.g. 120 McDowall Street Albury NSW 2640 Emergency contact information Emergency Contact Relationship To You Emergency Contact Name Emergency Contact's Telephone Number Employment Details & Other Company / Business Name Employment Type Employment Type Full Time Part Time Employer's Contract Person Employer's Phone Number Employer's Email Employer's Postcode Have you previously studied any training in relation to this course? Have you previously studied any training in relation to this course? YES NO If yes, please specify Consent Consent I consent for Licence Me to create a Unique Student Identifier (USI) on my behalf. I acknowledge that I have read and understood the USI privacy policy. I consent in the event of injury or illness for Licence Me to contact the appropriate person/s or medical assistance. I give Licence Me permission to use photos, videos taken of me for marketing and promotion. I acknowledge that providing false information on this enrolment form, or failing to disclose any relevant information, may result in the withdrawal of any course offer or cancellation of my enrolment. I agree all information provided is true and correct I Agree Submit
