Enrolment form

Title *

Given Name *

Middle name *

Surname *

Maiden name or any other name you have been known by *

Preferred name *

Mobile phone number *

Home phone number *

Street address line 1 *

Street address line 2 *

City/Suburb *

State *

Postcode *

Gender *

Male Female Other

Country of Citizenship *

Australian Citizenship Status *

Aboriginal or Torres Strait Islander Origin *

Proficiency in spoken English *

English assistance? *

Yes No

Attending Other Schools/College or University?? *

Yes No

Study reason *

Highest COMPLETED school level *

Disabilities *

Yes No Not specified

Prior Education *

Yes No Not specified

Year completed school *

If yes to the above question: *

Bachelor degree or higher degree Advanced Diploma or associate degree Diploma (or associate diploma) Certificate IV (or advanced certificate/technician) Certificate III (or trade certificate) Certificate II Other education

Unique Student Identifier (USI) *

Leaner Unique Identifier (LUI) (only provide this if this training is counting towards a Year 12 Certificate) *

Contact name *

Relationship *

Enrolment Form
for Accredited Certificate Courses

Learner Details

Contact Details

VET related fields

Student Identifiers

Emergency Contact Details

Course Information