Module Request Form

Module Request Form

Please complete all fields on this form. Ensure you sign and date this form prior to submitting your request.

Section 1 | Student details

Unique Student Identifier (USI)*
First name / Last name

*Module requests received without a USI or USI on file will not be processed. It only takes a few minutes to obtain a USI at www.usi.gov.au

Since January 1, it is now law that all students enrolled in a vocational program must have a Unique Student Identifier (USI). You will no longer be able to receive learning materials unless you provide your USI.

Section 2 | Module request

Following your qualification program sequence, select your next module/s from the table below (up to two modules may be requested).

Certificate III in Early Childhood Education and Care
Module 1 / Module 2 / Module 3 / Module 4 / Module 5
Module 6 / Module 7 / Module 8
Diploma of Early Childhood Education and Care
Module 1 / Module 2 / Module 3 / Module 4 / Module 5
Module 6 / Module 7 / Module 8 / Module 9 / Module 10
Module 11 / Module 12 / Module 13 / Module 14 / Module 15
Fees/charges
Please refer to the Institute’s website for the current course fee schedules.
Fee-for-service students will receive an invoice for payment for their requested module/s. These module/s will not be released to the student until full payment has been receipted.
Employer Funded Study students will have the cost of the module added to their student account. Employer Funded Study Students will only incur these module fees as outlined within the Employer Funded Study Assistance Terms and Conditions.

Section 3 | Module distribution

Please select from the following how you would like your module/s distributed to you:

Via email to
OR
Via post to

Section 4 | Student acknowledgement

By signing this form I understand the cost of the module I have requested will be added to the balance of my Student Account and/or payment may be required in order for the module to be released for study.

Student signature: ______Date: ______

This document is uncontrolled when printed. / IMPLEMENTATION DATE:
09/11/2015 / APPROVED:
Institute Manager
TITLE: Module Request Form v3.0