APPENDIX 5

NSW School Based Apprenticeship / Traineeship Notification

*Please tick appropriate box: Apprenticeship Traineeship

New Training Plan Amended Data Updated Training Plan Required

(Tick checkboxes against numbers on left to indicate amended data) (Change in Employer or RTO)

APPRENTICE / TRAINEE DETAILS

1 / *Name of Apprentice/Trainee / Given Names / Surname
2 / *Date of Birth / / / / *Student BOS Number / Male Female
3 / *Apprentice / Trainee Address
Suburb / State / Postcode

EMPLOYER DETAILS

4 / Legal Name of Employer
5 / *Trading Name of Employer / ABN
6 / *Employer Address
/ Suburb / State / Postcode
7 / *Employer Phone / Fax / Email
8 / *Employer Contact Name
9 / Host Employer/s
*Employer Signature / I give my permission for the above information to be used by TAFE NSW for the purpose of developing a training plan for this school based apprentice / trainee / Signature
Printed Name / Date / / /

AUSTRALIAN APPRENTICESHIP CENTRE (AAC) DETAILS

10 / *Name of AAC
11 / *Contact Person / *Phone
Mobile / Fax / Email

TRAINING DETAILS

12 / *Apprenticeship / Traineeship Name / *NTIS Code
13 / *Commencement Date of Apprenticeship / Traineeship / / / / Expected Completion Date of Apprenticeship / Traineeship / / /
14 / *TVET Course Name: / TVET Offer Code: / TAFE Course No:
15 / Flexible Delivery required: / Yes No / Campus:

SCHOOL DETAILS

16 / *Name of School / *Year at school in / 20_ _
17 / *School Contact Person / *Phone
Mobile / Fax / Email

REFERRAL DETAILS (LCP / SCHOOL / SCHOOL REGION / DIOCESE)

18 / Organisation Name
19 / SBA/T Coordinator / *Phone
Mobile / Fax / Email

TRAINING PROVIDER(S) DETAILS

21 / *RTO 1 (Issuing RTO) / *Contact Person
22 / *Phone / Mobile / Fax / Email
21 / *RTO 2 (If applicable) / *Contact Person
22 / *Phone / Mobile / Fax / Email

TAFE NSW SBA/T Notification Form Version: May 2008