(Please Tick One) Day Night RPL SECTION 1: COURSE DETAILS. Name of Training Program Applying for: Date of Enrolment: SECTION 2: PERSONAL DETAILS

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1 Please fill ALL sections below in BLOCK LETTERS and return the form to or post to Access Training and Education, PO Box 465, Moorooka QLD If you have any questions, please contact us on SECTION 1: COURSE DETAILS Name of Training Program Applying for: (Please Tick One) Day Night RPL Date of Enrolment: SECTION 2: PERSONAL DETAILS Title: (Please Tick) Mr Mrs Miss Ms Dr Other Given Name: Middle Name: Surname: Work Number: Mobile Number: Home Number: Address: Gender: Date of Birth: Country of Birth: City of Birth: Primary Postal Address: Building Name: Flat/Unit Details: Street Number/Name: Primary Street Address: Building Name: Flat/Unit Details: Street Number/Name: PO Box Details: City/Suburb: Post Code: State/Territory: City/Suburb: Post Code: State/Territory: Are you of Aboriginal or Torres Strait Islander origin? (for persons of both Aboriginal AND Torres Strait Islander, mark both Yes boxes) No Yes, Aboriginal Yes, Torres Strait Islander Enrolment Form 13A Ver 5 Apr

2 SECTION 3: UNIQUE STUDENT IDENTIFIER NUMBER: From 1 January 2015, Access Training & Education can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you have not provided us with a Unique Student Identifier (USI). If you have not yet obtained a USI you can apply for it directly at Enter your Unique Student Identifier Number: SECTION 4: LANGUAGE Do you speak a language other than English at home? No, English only (go to section 5) Yes, other please specify If Yes, how well do you speak English? Very Well Well Not Well Not at All Do you require English Assistance? Yes No SECTION 5: EMPLOYMENT STATUS (tick one box 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 SECTION 6: DISABILITY Do you consider that you have a disability, impairment or long-term condition? No (go to section 8) Yes, please indicate below (you may indicate more than one area) Hearing/Deaf Physical Intellectual Learning Mental Illness Acquired Brain Impairment Vision Medical Condition Other Enrolment Form 13A Ver 5 Apr

3 SECTION 7: EDUCATION Are you still attending secondary School? Yes No What is your highest completed school level? Did not go to school Completed year 8 or lower Completed year 9 Completed year 10 Completed year 11 Completed year 12 In which year did you complete that school level? Have you successfully completed any of the following qualifications? No (go to section 7) Yes (please tick any applicable boxes) Bachelor Degree or Higher Degree Advanced Diploma or Associate Degree Diploma (or Associate Diploma) Certificate IV (or Advanced Certificate/Technician) Certificate III (or Trade Certificate) Certificate II Certificate I Certificates other than the above SECTION 8: STUDY REASON (Tick ONE box only) Of the following categories, which best describes your main reason for undertaking this course/traineeship/apprenticeship? To get a job To start my own business To get a better job or promotion I want extra skills for my job For personal interest or self-development To develop my existing business To try for a different career It was a requirement of my job To get into another course of study Other reasons SECTION 9: RECOGNITION OF PRIOR LEARNING (RPL)/CREDIT TRANSFER Do you wish to apply for RPL/Credit Transfer? Yes No If you have ticked yes, we will contact you to make an appointment to discuss your training plan with staff. Enrolment Form 13A Ver 5 Apr

4 SECTION 10: ADDITIONAL INFORMATION ABOUT YOURSELF THAT COULD IMPACT ON YOUR STUDIES Would you like additional support with any special needs (literacy, numeracy, physical)? This information is confidential and is only used as a means to provide the best support possible to suit your individual needs. Please provide a brief description of the sort of support would best suit your individual needs. Access Training and Education is committed to ensuring we offer training opportunities to all people on an equal and fair basis. All participants who meet our entry requirements will be accepted into any of our training programs. Any questions regarding access and equity can be directed to the Chief Executive Officer. SECTION 11: CERTIFICATE 3 GUARANTEE (CERTIFICATE II AND III QUALIFICATIONS ONLY) Do you wish to apply for the Certificate 3 Guarantee Program? To check for eligibility, please visit Department of Education and Training website. No (go to section 11) Yes Have you been know under any other name? Do you have a concession card? No Yes Card Type: Have you completed or are currently enrolled in a Certificate III qualification or higher? No Yes Qualification: Please select from the following: (you may select more than one) Queensland resident Australian or New Zealand citizen Australian permanent residency Temporary resident with the necessary visa and work permits on the pathway to permanent residency SECTION 12: FEES, REFUNDS, COURSE CHANGES, CANCELLATIONS, TRANSFERS Enrolment Cancellation and Refund Policy Pre-enrolment information provided to students is designed to ensure that all details relating to fees and charges are known prior to enrolment. A non-refundable deposit of 20% of the total enrolment fee is payable on enrolment to any program or partial program. The balance of the program fees are to be paid as arranged with individual student. Access Training and Education will acknowledge an application for a cooling off period of ten (10) working days applicable from the date of the enrolment form and cease at C.O.B. on the tenth day. Enrolment Form 13A Ver 5 Apr

5 Should a student wish to withdraw between the time of the cooling off period and course commencement the following conditions shall apply. An application for refund of course fees under any other circumstance must be made in writing using Access Training and Education s Refund Request form (Doc.13C). A refund of 80% percent of all fees paid at the date of the written request will be made if the request is received more than five (5) working days prior to course commencement. A 20% refund of all fees paid at the date of request is available for requests received less than five (5) working days prior to course commencement. As a general rule no refund is available after the course commencement date. However, Access Training and Education will consider each application on a case by case basis. Refunds will be considered on a pro-rata basis for participants who fall ill, are injured to the extent that they can no longer undertake the course or experience other extenuating circumstances, providing a supporting medical certificate or other relevant supporting documentation is supplied to us. SECTION 13: GENERAL Where our training programs have a limited number of places available, these will be filled according to minimum entry requirement in the first instance and in order of completed bookings thereafter. If, for any reason Access Training and Education, or any party delivering training and assessment on our behalf, closes or ceases to deliver any part of the qualification in which a client has enrolled, Access Training and Education will assist the learning in locating another provider or refund the portion of fees for which training and assessment has not been provided. SECTION 14: DECLARATION I acknowledge that by completing and returning this form, I am entering into an agreement with Access Training and Education and that each party has a role to ensure a positive outcome. Access Training and Education hereby agrees to provide the training, assessment and resources necessary for me to achieve this qualification and I acknowledge my role and responsibility in this agreement, including the full payment of student fees. I acknowledge that I have read and understood the information provided. I confirm that the information provided by me is true and correct. I have been offered the opportunity for Recognition of Prior of Learning relating to this course and agree to the conditions set out previously. I understand that information contained in these forms may be provided to State and Commonwealth Agencies and Research Organisations and I consent to that occurring. I give Access Training and Education authorisation to perform a search on previously held qualifications, to ensure eligibility for the Certificate 3 Guarantee Program through DETConnect. Student Name: Signature: Date: Enrolment Form 13A Ver 5 Apr

6 Please attach to this form a copy of: Photo ID Concession Card Return this completed form to study@deafsq.org.au or post to Access Training and Education, PO Box 465, Moorooka QLD If you have any questions, please contact us on Enrolment Form 13A Ver 5 Apr

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