RTO 91000
In third party arrangement with
SOUTH
Application for Enrolment Form 2017
National College Australia (NCA) as the lead RTO to ensure all obligations regarding RTO registration standards are met, including the issue of qualifications and statements of attainments that relate to the medication and first aid units.
MEDECS Australia have the expertise in the area of medication administration and First Aid in both community based and health settings. They employ only Registered Nurses with the required national Trainer/Assessor competencies to deliver and assess the units. The medication administration accreditation program and First Aid accreditation programs, including delivery and assessment resources, have been designed and developed by MEDECS Australia in consultation with NCA.
Checklist before submitting your enrolment form
Completed all sections
Read & understood the cancellation policy
Selected the relevant course by placing a tick in the box
Selected a final assessment session time by placing a tick in the relevant box
Section (4) filled in
Nominated supervisor identified (Assist clients with medication unit only)
Please note that all enrolments close by 5.00pm 48 hours before the allocated workshop you are to attend
Instructions
Please fill in all sections clearly and carefully by writing in block letters. Information requested on this form is also for national database and tracking purposes and assists in qualification issuance.
1. PERSONAL DETAILS
Title: (Please tick) Mr Ms Mrs Miss OtherFamily Name:
Given Names:
Residential Address:
Post Code:
Postal Address: / Post Code:
Phone Numbers: / Home: / Work: / Mobile:
Email:
Date of Birth: / Country & Town of Birth: / Gender: M F
Next of Kin & Relationship: / Best phone No.:
Please provide your ‘Unique Student Identifier’ (USI) if you already have one or if not please provide either your Drivers License or Medicare Number. By ticking the ‘Y’ box you agree to SET obtaining it for you:
Y N
If you have a Unique Student Identifier please provide:
Drivers Licence: / OR / Medicare No: ( ) Exp date:
(Please put the number you are on card in the brackets)
2. 2017 Course Details
This enrolment form is for the following units (Place X in the unit/s you are enrolling for):
HLTHPS006 – Assist Clients with Medication (maximum 12)
HLTAAP001 – Recognise Healthy Body Systems (maximum 12)
First Aid Full Course - Option 1 - 2-day Program (new entrants) HLTAID003 – Provide First Aid & HLTAID001 Provide Cardiopulmonary Resuscitation (maximum 10)
First Aid Full Course - Option 2 - 2-day Program (new entrants) HLTAID003 – Provide First Aid & HLTAID001 Provide Cardiopulmonary Resuscitation (maximum 10)
First Aid Refresher Course – Option 1 – 4-hour workshop and online (Refresher to be completed every 3 years) HLTAID003 – Provide First Aid & HLTAID001 Provide Cardiopulmonary Resuscitation (maximum 10) (You must be prepared to complete pre-workshop activities on enrolment in this program)
First Aid Refresher Course – Option 2 - 1-day workshop and hardcopy (Refresher to be completed every 3 years) HLTAID003 – Provide First Aid & HLTAID001 Provide Cardiopulmonary Resuscitation (maximum 10) (You must be prepared to complete pre-workshop activities on enrolment in this program)
Please note all places are allocated on a ‘first in’ basis. If your preferences are not available you will be allocated a place in the next available course or assessment session. You will receive a confirmation notice to confirm your enrolment details.
Please also note that it is a requirement under the Disability Services Medication Management Framework (Department of Health and Human Services) that all staff administering medications complete both HLTHPS006 Assist Clients with Medication, HLTAAP001 Recognise Healthy Body Systems and hold a current First Aid Certificate. If you have not already completed the Healthy Body Systems unit as part of your qualification please ensure you enrol in that unit as well as the Assist Clients with Medication Unit.
i) Please select the specific course/s below by placing a tick in the selection box of the course required and
ii) Please select preferred final assessment session time for Medication training. Please tick only one preference time.
HLTHPS006 – Assist Clients with MedicationTechnopark – Suite 1, Main Building, Innovation Drive, Dowsing Point
Code / Workshops / Final
Assessment / Select
Box √ / Preferred final assessment session √
MS1 / Tuesday 17th January
Wednesday 18th January / Tuesday 7th February / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS2 / Wednesday 1st February
Thursday 2nd February / Tuesday
28th February / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS3 / Thursday 16th February
Friday 17th February / Friday 10th March / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS4 / Thursday 16th March
Friday 17th March / Friday 21st April / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS5 / Monday 3rd April
Tuesday 4th April / Tuesday 2nd May / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS6 / Thursday 27th April
Friday 28th April / Friday 26th May / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS7 / Thursday 18th May
Friday 19th May / Friday 16th June / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS8 / Thursday 8th June
Friday 9th June / Friday 7th July / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS9 / Wednesday 21st June
Thursday 22nd June / Thursday 20th July / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS10 / Tuesday 4th July
Wednesday 5th July / Wednesday 2nd August / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS11 / Monday 31st July
Tuesday 1st August / Tuesday 29th August / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS12 / Thursday 24th August
Friday 25th August / Thursday 21st September / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS13 / Monday 4th September
Tuesday 5th September / Monday 2nd October / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS14 / Wednesday 27th September
Thursday 28th September / Wednesday 25th October / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS15 / Wednesday 4th October
Thursday 5th October / Thursday 2nd November / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS16 / Monday 30th October
Tuesday 31st October / Tuesday 28th November / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS17 / Monday 13th November
Tuesday 14th November / Tuesday 12th December / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
MS18 / Tuesday 5th December
Wednesday 6th December / Thursday 21st December / ð 9.00am ð 10.00am ð11:00pm ð 1.00pm
ð 2.00pm ð 3.00pm ð
HLTAAP001– Recognise Healthy Body Systems
Please note your assessment for this unit can be done together with your assessment for Assist Clients with Medication or standalone.
Code / Workshops / Select
Box √
HBS1 / Monday 16th January
HBS2 / Thursday 9th February
HBS3 / Tuesday 14th March
HBS4 / Friday 7th April
HBS5 / Thursday 11th May
HBS6 / Tuesday 13th July
HBS7 / Friday 21st July
HBS8 / Thursday 17th August
HBS9 / Thursday 7th September
HBS10 / Wednesday 18th October
HBS11 / Friday 10th November
HBS12 / Friday 1st December
FIRST AID FULL PROGRAM
Option 1
(Two day workshop) / FIRST AID FULL PROGRAM
Option 2
(One day + online)
Code / Workshops
9.00 – 4.00pm / Select
Box √ / Code / Workshops
9.00 – 4.00pm / Select
Box √
2FAS1 / Thursday 23rd February
Friday 24th February / 1FAS1 / Tuesday 24th January
2FAS2 / Monday 10th April
Tuesday 11th April / 1FAS2 / Thursday 23rd March
2FAS3 / Tuesday 6th June
Wednesday 7th June / 1FAS3 / Monday 15th May
2FAS4 / Tuesday 8th August
Wednesday 9th August / 1FAS4 / Tuesday 18th July
2FAS5 / Thursday 19th October
Friday 19th October / 1FAS5 / Wednesday 13th September
1FAS6 / Thursday 16th November
1FAS7 / Monday 18th December
FIRST AID REFRESHER PROGRAM
Option 1
(4 hour workshop + online) / FIRST AID REFRESHER PROGRAM
Option 2
(One day workshop + hard copy)
Code / Workshops
9.00 – 1.00pm / Select
Box √ / Code / Workshops
9.00 – 4.00pm / Select
Box √
FARS1 / Friday 20th January / 1FARS1 / Wednesday 25th January
FARS2 / Monday 23rd January / 1FARS2 / Monday 6th February
FARS3 / Tuesday 21st February / 1FARS3 / Tuesday 21st March
FARS4 / Wednesday 8th March / 1FARS4 / Wednesday 26th April
FARS5 / Thursday 6th April / 1FARS5 / Tuesday 23rd March
FARS6 / Thursday 4th May / 1FARS6 / Friday 23rd June
FARS7 / Monday 5th June / 1FARS7 / Thursday 27th July
FARS8 / Wednesday 12th July / 1FARS8 / Monday 28th August
FARS9 / Friday 11th August / 1FARS9 / Friday 29th September
FARS10 / Monday 11th September / 1FARS10 / Monday 23rd October
FARS11 / Friday 6th October / 1FARS11 / Monday 27th November
FARS12 / Friday 3rd November / 1FARS12 / Friday 15th December
FARS13 / Friday 8th December
3. Employment Details
Full-time employee Permanent part-time employee Casual employeeName of Employer:
Address:
Town/Suburb: / Postcode:
Telephone: / Fax:
Workplace Supervisor: / Phone:
Supervisor Email:
Credit Card Details (if self funded)
Visa MasterCard Exp Date: ___/___
Card No:Cardholder Name: ______Cardholder Signature: ______
Assist Clients with Medication - $475
Recognise Healthy Body Systems (as part of the medication skill set) - $150
Recognise Healthy Body Systems (Standalone unit) - $250
First Aid Full Program – Option 1 - $200
First Aid Full Program – Option 2 - $175
First Aid Refresher – Option 1 - $150
First Aid Refresher Program – Option 2- $175
4. nominated supervisor (Assist clients with medication unit only)
Eligibility criteria: (Please read criteria below before proceeding any further)
· Supervisor must be an experienced staff person in a senior role to the training participant.
· Supervisor has achieved the minimum required accreditation standards in medication administration and has been currently practicing those competencies for a minimum of 2 years.
· Supervisor is able to mentor & co-assess the participant throughout the duration of the program and able to assist the participant in the completion of assessment activities if required.
· Supervisor is able to maintain monitoring contact with the Medecs program facilitator when required.
Nominated Workplace Supervisor: ______Mobile: ______
5. cancellation policy
MEDECS cancellation
If in the unlikely event any program is cancelled by MEDECS Australia, then a full refund of all fees paid up until that point will be refunded.
Participant cancellation
Cancellation notice for all enrolments will be accepted up until 5.00pm 48 hours prior the course commencement day. A cancellation fee of $35.00 will be charged in this instance to cover the administration costs required. Should the enrolment be cancelled after this time full fees will be charged to the employer.
Once the first day of a course commences then all enrolled participants will be charged. There are no refunds after the commencement day of each course.
6. education
What is your highest completed school level?Year 12 Year 11 Year 10
Year 9 or equivalent Year 8 or lower Did not go to school
In which year did you complete that school level?______
Have you completed any of the following national qualifications? No Yes – Please tick below
Certificate I Diploma (or Associate Diploma)
Certificate II Advanced Diploma or Associate Degree
Certificate III (or trade certificate) Bachelor Degree or Higher Degree
Certificate IV (or Advanced Certificate/Technician) National Qualifications other than the above
Year(s) Completed:______
7. Language and Cultural Diversity
Are you of aboriginal or Torres Strait Islander origin? No Aboriginal Torres Strait Islander(For persons of both Aboriginal AND Torres Strait Islander origin, mark both “Yes” boxes)
Were you born in Australia? Yes No, please specify:______
Do you speak a language other than English at home?
No, English only (Go to section 8)
Yes, please specify:______
If yes, how well do you speak English?
Very Well Well Not well Not at all
8. Additional Learning Needs
Do you consider that you have a disability, impairment or long-term condition that may impact your learning? (You may indicate more than one area)
No (Go to section 8)
Yes, please specify below:
Vision Hearing Physical Medical Condition
Other (please specify):______
Language, Literacy and Numeracy skills (LLN)
The qualification or course you are enrolling in will require a foundation level of LLN skills. Please tick the box(es) below if you require additional assistance in any of these areas. If you are unsure please request a confidential LLN self-assessment form to complete. If further assistance is required we will contact you and provide details of a confidential training service.
Not Applicable Language (English) Literacy (Ability to read or write)Numeracy (Ability to understand and apply number concepts)
9. Consent
Individuals will be advised firstly of a ‘not yet competent result’ in the functional English, literacy & numeracy assessment (Assist clients with medication unit only). This information will then be shared with the current employer if applicable to be able to arrange suitable training support. By signing the declaration below all parties understand & agree if the situation arises, for this to occur.
Personal information will be managed in accordance with the Personal Information Protection Act 2004. I understand that National College Australia will not pass this information to any other party without my written permission.
10. Training Agreement
The obligations of Medecs Australia / National College Australia
Medecs Australia is undertaking to deliver and assess you in the qualification or unit(s) outlined in section two of this application form. The cost and payment options for this qualification/unit are outlined in section three of this application. This information below outlines the services you are to be provided by Medecs Australia/National College Australia. These include the following: