Confidential Enrolment Form (v2) - Accredited "*" indicates required fields Step 1 of 3 33% Thank you for enrolling in an Australian College Course. The Government requires us to collect certain information from you to include with your enrollment. This is a simple process containing just 3 steps and will take you only a few minutes to complete. Read our Privacy Notice here and our Terms and ConditionsStep 1 – Your Course and Contact DetailsThank you for choosing to enrol in an Australian College Course. To make the process as easy as possible please have the course information handy. Enrolling is a simple process which takes only a few minutes to complete. Before your start completing this form, read our Privacy Notice and our Terms and Conditions. FacultyCourseEnter your contact detailsPlease write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names. If you do not yet have a USI you must apply for a USI as part of your enrolment. For information on how to obtain an USI, please see section on the USI at the end of this form for a detailed explanation.) If you have one name only (ie. no Given Name/Surname) write your single name in both Given and Family Name fields.TitleSelect TitleMrMrsMissMsDrName* Given names Family name (surname) Date of Birth* DD slash MM slash YYYY Gender*Select GenderMaleFemaleOtherPhone*Email* Please provide the physical address (street number and name, not post office box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home. If you are from a rural area use the address from your state or territory's 'rural property addressing' or 'numbering' system as your residential street address.Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Postal address the same as above address?*YesNoAddress* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Step 2 - Required Data CollectionCommonwealth and State Governments require us to collect the below information for research and statistical purposes. If any field is not applicable, please leave it blank.In which country were you born?* Australia Other Please SpecifyDo you speak a language other than English at home?* No, English only Yes, other (If more than one language, indicate the one that is spoken most often)Please SpecifyAre you of Aboriginal or Torres Strait Islander origin?* No Yes, Aboriginal Yes, Torres Strait Islander (For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)Disability - Before completing this section, please read the ‘Disability Supplement’ information provided here.Do you consider yourself to have a disability, impairment or long-term condition?* Yes No If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:(You may indicate more than one area) Please refer to the ‘Disability Supplement’ for an explanation of the following disabilities. Hearing/deaf Physical Intellectual Learning Mental illness Acquired brain impairment Vision Medical condition Other SchoolingWhat is your highest COMPLETED school level? (Tick ONE box only)If you are currently enrolled in secondary education, the highest school level completed refers to the highest school level you have actually completed and not the level you are currently undertaking. For example, if you are currently in Year 10 the highest school level completed is Year 9. Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or below Never attended school (Never completed any primary or secondary level education) Are you still enrolled in secondary or senior secondary education?* Yes No Previous qualifications achieved Have you SUCCESSFULLY completed any of the qualifications listed on the right?* Yes No If ‘Yes’, tick ANY applicable boxes. 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 Certificate I Other education (including certificates or overseas qualifications not listed above) Employment Of the following categories, which BEST describes your current employment status? (Tick one box only)*For casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full time (35 hours or more per week) or part-time employed (less than 35 hours per week). 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 Study Reason Of the following categories, select the one which BEST describes the main reason you are undertaking this course/traineeship/apprenticeship (Tick ONE box only)* To get a job To develop my existing business To start my own business To try for a different career To get a better job or promotion It was a requirement of my job To get into another course of study For personal interest or self-development To get skills for community/voluntary work Other reasons Unique Student identifier (USI) From 1 January 2015, Australian College can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). In addition, we are required to include your USI in the data we submit to NCVER. If you have not yet obtained a USI you can apply for it directly at https://www.usi.gov.au/students/create-your-usi on your computer or mobile device.Enter your Unique Student Identifier (USI) (if you already have one)You may already have a USI if you have done any nationally recognised training, which could include training at work, completing a first aid course or RSA (Responsible Service of Alcohol) course, getting a white card, or studying at a TAFE or training organisation. It is important that you try to find out whether you already have a USI before attempting to create a new one. You should not have more than one USI. To check if you already have a USI, use the ‘Forgotten USI’ link on the USI website at https://www.usi.gov.au/faqs/i-have-forgotten-my-usi/.To ensure the authenticity of your USI, Australian College must verify the information available on the USI Register. Please, provide details for one of the forms of identity below. You must ensure that the name written in ‘Personal Details’ section of this Enrolment Form is exactly the same as written in the document you provide below.Australian Driver’s licenceStateAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaLicence NumberMedicare CardMedicare card numberIndividual reference number (next to your name on Medicare card)Card colour: (select which applies) Green Yellow Blue Expiry dateAustralian Birth Certificate Details vary according to State/TerritoryState/TerritoryDetails vary according to State/TerritoryAustralian Capital TerritoryNew South WalesNorthern TerritoryQueenslandSouth AustraliaTasmaniaVictoriaWestern AustraliaAustralian PassportNon-Australian Passport (with Australian Visa)ImmicardCitizenship CertificateStock NumberCertificate of Registration by Descent DD slash MM slash YYYY Acquisition date Step 3 - Final StepsAny comments or messagesNote In accordance with section 11 of the Student Identifiers Act 2014, Australian College will securely destroy personal information which we collect from individuals solely for the purpose of verifying the USI on the student’s behalf as soon as the verification process is complete or the information is no longer needed for that purpose. A photo ID is required as part of Australian College enrolment process – this will be kept on the student’s file for the duration of the enrolment or as required by relevant laws and legislation. For more information, see Australian College Privacy Policy and Student Record Management Policy.Consent* I have read and understand the Student Handbook*Consent* I have read and agree to the Enrolment Terms and Conditions*Consent* I have read and agree to the Australian College Fees and Charges*Consent* I have read and agree to the Privacy Notice*Consent* I have read and understand the Disability Supplement*Consent I will send a copy of my passport/visa (travel documents) to [email protected] and consent to have these verified via VEVO visa check (only required if you are not an Australian Citizen)Signature*
