Last Name
Given Name/s / Title / Mr / Miss / Mrs / Ms
Date of birth / Gender / Male Female
Phone / USI (Unique Student ID #)
Visit - Usi.gov.au
Email address
Residential address
Suburb
State / Postcode
Postal address
Suburb
State / Postcode
100 Points of ID / Attached? Yes No
Do you have a criminal history or a pending court case against you? Yes No
Emergency Contact Details
Emergency Contact Name
Relationship to Student
Emergency Contact Phone Number
Language and Cultural Diversity
In which country were you born? (please tick one)
Australia Other (please specify) ______City: ______
Are you an Australian Citizen or Permanent Resident? / Yes No
Are you living in Australia on a temporary Visa? / Yes No (if yes please attach details)
Do you speak a language other than English at home? (please tick one)
No, English only Yes, other (please specify) ______
How well do you speak English? (please tick one)
Very well
Well / Not well
Not at all
Are you of Aboriginal or Torres Strait Islander origin? (please tick one)
No Yes, Aboriginal Yes, Torres Strait Islander
Disability
Do you consider yourself to have a disability, impairment or long-term condition that could affect learning? / Yes No
If YES, then please indicate the areas of disability, impairment or long-term condition:
(please tick - you may indicate more than one area)
Hearing/Deaf
Medical condition
Acquired brain impairment / Physical
Hearing/Deaf
Learning / Intellectual
Vision
Other
Education
What is your highest COMPLETED school level? (please tick one only)
Year 12 or equivalent
Year 11 or equivalent
Year 10 or equivalent / Year 9 or equivalent
Year 8 or below
Never attended school
In which YEAR did you complete that school level?
Are you still attending secondary school? / Yes No
Previous Qualifications Achieved
Have you SUCCESSFULLY completed any of the following qualifications in Australia. / Yes No
If YES, then tick any applicable boxes:
Bachelor Degree or Higher Degree
Advanced Diploma or Associate Diploma
Diploma (or Associate Diploma)
Certificate IV (or Advanced Cert/Technician / Certificate III (or Trade Cert) CertificateIII at school
Certificate II
Certificate I
Other Certificates
Employment
Of the following categories, which BEST describes your current employment status? (please tick one only)
Full-time employee
Part-time employee
Self-employed - not employing others
Employer / Employed - unpaid worker in family business
Unemployed - seeking full-time work
Unemployed - seeking part-time work
Not employed - not seeking employment
Study Reason
Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship? (please tick one 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
I wanted extra skills for my job
To get into another course of study
For personal interest or self-development
Other reasons
Course Enrolment Details
I want to study at:
Location (City) / Bundaberg Toowoomba
Cairns Townsville
HerveyBay / Day Course OR Night Course
(Selected locations only)
Correspondence Online
I would like to study: / CHC33015- Certificate III Individual Support (Ageing)
Home and CommunitySpecialisation (additional Cost)
Disability Specialisation (additional Cost)
HLTCSD305D Assist with ClientMovement HLTAID001ProvideCPR
If you would like more than one specialisation please call the office to confirm availability.
I am / A Full Fee Student
Job Service Provider Information (only complete if referred by a Job Provider)
Job Seeker ID Number
Job Service Provider Name
Street Address / State
Town / Suburb / Postcode
Contact Person / Name
Phone
Mobile
Survey
How did you hear about AustCare Training Australia?
Internet search / AustCare Website / Existing / Past Student / TV
Newspaper / Radio Advertisement / Employment Services
Centrelink / Social media (Facebook, Twitter, etc.)
Referral from a former Austcare Student
Former Students Name
Contact Phone Number
Privacy Policy
The primary purpose in collecting your information is to fulfil our business commitments to you in providing education and training.
We may use the information you provide to help improve the services we deliver to you, measure interest in our services, inform you of other products and services or to comply with requirements under the law. We shall not otherwise disclose your personal information to any other party without your consent and we do not sell personal information to third parties.
Refund Policy
You must advise us of cancellation in writing or by email. All monies, less a 20% administration fee, will be refunded if cancellation occurs at least one week before any training or assessment takes place. Cancellation after training or assessment begins will attract a 20% administration fee and the deduction of the full cost of any training or assessmentthe learnerhad access toup until cancellation date. In the case of online learning, training and assessment is deemed to have commenced once the learner has been issued a username and login and these have been used to access the online material.
- I have attached a copy of my driver’s license/photo identification and 100 point ID
- I have completed the enrolment form and provided all required information
- I understand my rights and responsibilities as a student and will receive a student handbook on commencement of my course.
- I consent to having my personal information being used in accordance with the privacy policy stated above.
- I have been informed of, and hereby agree to abide by, the RTO policies and procedures relating to fees, charges and regulations of the organisation.
- I declare that the information supplied on this form is correct and complete.
- I consent to AustCare Training creating a USI number on my behalf.
Agreement
- Upon you returning the signed original enrolment form to AustCare Training ("Agreement Date") a binding agreement shall arise between you and AustCare Training ABN 32 219 381 422 and shall be governed by State Law.
- By signing and returning this enrolment form you agree that your personal details as recorded on the enrolment form will be provided to our RTO XXXX - (AustCare Training) – for registration in the database to enable certificate issue and for reporting purposes.
- By signing and returning this enrolment form you agree to pay the course fee for the course/s you have selected under this agreement.
- Course materials will be provided to you upon commencement of the course. AustCare reserves the right to withhold the provision of course materials in the event you fail to pay any part of the course fee.
- The course fee does not cover postage to AustCare Training, recommended textbooks or any additional reading materials.
- Subject to the successful completion of all units of competency, and course fees being paid in full, a certificate for your course will be issued by AustCare Training (Registered Training Organisation No. XXXX).
- If a payment plan is arranged and you fail to pay the instalment by the due date, you will be subject to an administration fee of 10% of your overdue fee.
- The course materials that AustCare Training provides shall become your property. However, the content of the materials, including copyright and intellectual property rights contained therein remain the property of AustCare Training or the copyright owner. You may not reproduce any part of the course workbooks or materials without the written consent of AustCare Training.
- The duration of the course is outlined in the information provided by Austcare Training to you upon enquiry, in the event that you do not complete the course within the given timeframe, your course will be cancelled without refund. Extensions are subject to availability and AustCare Training retains the right to refuse an extension in its discretion.
- To secure placement a non-refundable deposit is to be paid 14 days before course commencement. Fee balance is required in full before certification is issued. Refunds prior to course commencement are payable as per the refund policy in the student’s handbook.
- For courses which contain a mandatory work placement component, AustCare Training will undertake and assist to provide students with work placements in an appropriate organisation. In the event that you have previously arranged a work placement AustCare Training will confirm the suitability of this arrangement and liaise with appropriately qualified supervisors on your behalf.
- If your behaviour is deemed unsatisfactory and/or your initial placement is cancelled, AustCare reserves the right to place you in another facility at it’s own discretion, or dismiss you immediately from the course without refund.
Student Declaration:
I acknowledge that the information on this form and any supporting documentation is correct and complete. I have read and understood the Terms and Conditions of Enrolment.
Applicant’s Full Name: ______
Applicant’s Signature: ______Date: ______
Please Attach 1 Form of I.D from Each Box and TICK WHEN ATTACHED.
------
- I am over 17 yrs old. YES NO
- I have completed a certificate 3 or higher qualification YES NO
- I am an Australian or New Zealand resident. YES NO
- Do you hold a health care card or a concession card? YES NO
Office use only - Authorised AustCare / RTO delegate:
Name: ______
Position: ______
Signed: ______Date: ______
Returned YES NO
NOTES
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