Enrolment Form

Qualification enrolling in:

Do you currently hold a Unique Student Identifier (USI)? / Yes No
If Yes, what is your number?
If no please use this link and create one https://www.usi.gov.au/students/create-your-usi
Drivers Licence number and State OR Medicare number are required to verify enrolment
** Drivers Licence No / ** State held
** Medicare Number / ** Position Number on card
** Exact spelling of name on card

** Denotes Mandatory Information Required

** Last Name / First Name
** Middle Name/s / Preferred Name
** Title / Mr Mrs Ms Miss Other
** Gender / Male Female
** Date of Birth / ** Town/City of Birth
** Mobile phone / A mobile phone number OR email address is required to verify enrolment
** Email Address
Home phone / Work phone
** Residential Address
Postal Address
(if different from
residential address)
Emergency contact (If under 18)
Name: / Phone number:
Statistical Information
Schooling
Are you currently attending secondary school? / Yes No
Have you successfully completed any of the following qualifications in Australia?
Certificate I / Certificate IV / Associate degree
Certificate II / Diploma / Bachelor degree or higher
Certificate III / Advanced diploma
What is the highest level of schooling you have completed?
What year did you complete that level of schooling (eg. 1996)
Statistical Information
Which of the following best describes your current employment status?
Full time employee / Unpaid worker in family business
Part time / casual employee / Unemployed – seeking full time work
Self employed – not employing others / Unemployed – seeking part-time work
Employer / Unemployed – not seeking work
Do you speak a language other than English at home? / Yes No
If yes, please specify:
If you speak a language other than English at home, how well do you speak English?
Very well / Well / Not well / Not at all
Residency details
In what country were you born?
Are you an Australian citizen or permanent resident? / Yes No
Do you identify as being of Aboriginal or Torres Strait Islander?
Yes Aboriginal
Yes Torres Strait Islander
Do you consider yourself to have a disability, impairment or long-tem condition?
No
Yes (please state)
Intellectual / Hearing / Deaf
Vision / Mental Illness
Physical / Medical Condition
Learning / Other (please state) ______
Acquired brain injury or impairment
What is your main reason for study?
To help gain employment / It was a requirement of my job
To develop my existing business / I wanted extra skills for my job
To start my own business / To get into another course of study
To try for a different career / For personal interest or self-development
To help get a better job or promotion / Other reason (please state)
Student Declaration
I have honestly and accurately provided information contained on this enrolment form. I understand any offer or any subsequent enrolment in a training place made on the basis of false or misleading information may be withdrawn by the Training Provider and/or the Minister for Employment, Higher Education and Skills.
Student consents to collection, use and disclosure of personal information by the Training Provider. Ascent Training Group stores personal information within the Privacy Principle Guidelines
Name
Signature / Date