Enrolment Form

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Course Enrolment

Select Course*

HLTAID009HLTAID011HLTAID012HLTAID014

Date of Certificate*

Delivery* Location

VICNSWSAQLDWAACTTAS

Trainer*

Abbas – VCTD-VICAnal – VCTD-VICAbdi - VCTD-WAAydarus – VCTD-VICDhrubajoty - VCTD-VICFatima – VCTD-NSWHafiz – VCTD-VICHaych – VCTD-VICKavita - VCTD-NSWOmar – VCTD-QLDReena – VCTD-VICSafi – VCTD-VICShivani – VCTD-VICUmer – VCTD-VICMuhammad – VCTD-Aus

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Student Details

First Name*

Middle Name

Last Name*

Email*

Mobile*

Sex*

MaleFemaleother

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Date of Birth*

Enter unit No

Enter Street No*

Enter Street Name*

Enter Sub*

Enter State*

Enter postcode*

Enter Country of Birth*

USI*

I confirm I have a valid USI or will obtain one before certification.

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I confirm that I have a valid Unique Student Identifier (USI) or will obtain one prior to certification. I authorise Australian People Management Institute (APMI – RTO 45114) to collect, verify, store, and use my USI for the purposes of training administration, assessment, certification, and reporting in accordance with the Privacy Act 1988 and the VCTD Policy page.

If you do not have a USI, you can create one at www.usi.gov.au. APMI cannot issue a Statement of Attainment or qualification without a verified USI.

Language spoken at home*

Are you of Aboriginal or Torres Strait Islander origin?*

NoYes, AboriginalYes, Torres Strait IslanderYes, Both

Disability*

Do you have a disability?

NoYes

If yes, please tick all that apply:

Hearing / DeafPhysicalIntellectualLearningMental illnessVisionAcquired brain impairmentMedical conditionOther

Schooling

What is your highest COMPLETED school level?

Year 12Year 11Year 10Year 9Year 8 or belowNever attended

Are you still enrolled in secondary education?

NoYes

Previous Qualifications

Have you successfully completed any qualifications?

YesNo

If YES, tick all that apply:

Bachelor Degree or Higher DegreeCertificate IV or Advanced Cert/TechnicianAdvanced Diploma or Associate DegreeCertificate III (or Trade Certificate)Diploma (or Associate Diploma)Certificate IICertificate IOther education (including overseas qualifications)

Employment

Which BEST describes your current employment status?

Full-time employeePart-time employeeSelf-employed - not employing othersSelf-employed – employing othersEmployed – unpaid in family businessUnemployed - seeking full-time workUnemployed - seeking part-time workNot employed - not seeking employment

Study Reason

Which BEST describes your main reason for undertaking this course?

To get a jobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better job or promotionIt was a requirement of my jobI wanted extra skills for my jobTo get into another course of studyFor personal interest or self-developmentOther reasons

Marketing / Source

Where did you hear about VCTD?

OtherFacebookTwitterWebsiteReferred FavorablyWorkplace

Declarations and Consents (Mandatory)

Please read each statement carefully and confirm before submitting your enrolment.

I confirm that I have read and understood the course information and training requirements prior to enrolment. I acknowledge that I have read and understood the VCTD Policy page, including Fees and Refunds, Enrolment Conditions, Complaints and Appeals, and Privacy information. I understand that assessment is conducted in accordance with unit requirements and that certification is issued only after successful completion, trainer assessment, and administrative approval. I declare that the information provided in this enrolment form is true and correct to the best of my knowledge. I consent to the collection, use, and disclosure of my personal information in accordance with the Privacy Policy published on the VCTD Policy page.

Photo ID*

Passport / Medicare