COURSE APPLICATION FORM & PRE-TRAINING REVIEW INTRUCTIONS 1. Complete Sections 1 8 and Sections 10-12 2. If you are applying for government funding under the Skills First Program, complete Section 9 (For Victorian Students Only) 3. If you are applying for Skills Recognition, attached supporting documentation of academic results and employment experience as detailed in Section 8. 4. Attach any other supporting documentation required Section 9. 5. Send all required certified documents to NPT Heart c/o 20-22 Hardner Road, Mt Waverley, 3149. Note emails of copies of the documents can also be emailed to heart@nptgroup.com.au. Please note that original certified documents MUST also be sent via mail in order to validate your application. This form also forms part of a pre-training review to assist NPT Heart to: Identify current competencies previously acquired (RPL, recognition of current competency (RCC) or credit transfer) Ensure that the applicant is suited to the qualification based on previous educational attainment, capabilities, career aspirations and interests Assist in ascertaining the proposed learning strategies and materials are appropriate Assess the applicant s digital capability, including access to necessary technology to enable the applicant to access and complete the online pre-reading and assessment materials.
SECTION 1 : COURSE DETAILS Course Name HLT31115 Certificate III in Non-Emergency Patient Transport HLT41115 Certificate IV in Health Care HLT51015 Diploma of Paramedical Science Dual Qualification : HLT41115 Certificate IV in Health Care & HLT51015 Diploma of Paramedical Science Driving for the NEPT Sector (including HLTAMB014 Transport non-emergency patients under operational conditions & HLTAMB003 Transport emergency patients) Preferred Classroom Start Date SECTION 2 : PARTICIPANT DETAILS Participant s Full Name Residential Address (FAMILY OR SURNAME) (GIVEN NAMES) Sex (Select one only) Male Female Inderminate / Intersex / Unspecified Postal Address (if different from above) Phone: (Home) (Mobile) Date of Birth / / Email: Emergency Contact (Phone) Relationship Drivers Licence Number Note: a certified copy of your drivers licence must accompany this enrolment form. National Police Check Note: a certified copy of your National Police Check must be provided prior to commencement of the Course. This must not be more than 6 months old. Working with Children Note: a certified copy of your Working with Children Check must be provided prior to commencement of the Course Unique Student Identifier (USI): Note : From 1 January 2015, NPT Heart can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your program if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI you can apply for it directly at http://www.usi.gov.au/create-your-usi/ on computer or mobile device. Victorian Student Number (VSN): To be completed by all students aged up to 24 years: Since 2009 in schools and since 2011 for vocational education and training (VET) organisations and Adult Community Education providers, a Victorian Student Number (VSN) has been allocated upon enrolment to each individual student aged up to 24 years. Students should report their VSN on all subsequent enrolments at a Victorian school or training organisation. In particular, all students who are currently enrolled in either License Number: Expiry Date: Date of Issue: Date of Issue: No more questions if you provided your VSN. 2
a VET provider or a Victorian school (including those already participating in a VET in schools program) should obtain their VSN from their current education or training organisation and report their VSN on this enrolment form. Students who are enrolling for the first time since the VSN was introduced will get a new VSN. Have you attended any Victorian school since 2009 or done any training with a vocational education and training (VET) registered training organisation or an Adult and Community Education provider in Victoria since 2011? No - I have not attended a Victorian school since 2009 or a TAFE or other VET training provider since the beginning of 2011 No more questions if you answer No above. Yes - I have attended a Victorian school since 2009: Please list most recent Victorian school attended. and / or Yes I have participated in training at a TAFE or other training organisation since the beginning of 2011 List the most recent training organisations with which you have participated in training in Victoria since 2011 (List up to 3 training organisations)... SECTION 3 - EMPLOYMENT STATUS Of the following categories, which BEST describes your current employment status? Full Time Employee Part Time Employee Casual Employee Unemployed seeking full time work Employed unpaid worker in family business Employer Self Employed not employing others Unemployed seeking part time work Not employed not seeking employment If you are currently employed, which of the following classifications BEST describes your current or recent occupation?: (Tick ONE box only) 1 Managers 2 Professionals 3 Technicians and Trade Workers 5 Clerical and Administrative Workers 7 Machinery Operators and Drivers 4 Community and Personal Service Workers 6 Sales Workers 8 Labourers 9 Other 3
Which of the following classifications BEST describes the industry in which you are working : (Tick ONE box only) A Agriculture, Forestry and Fishing C - Manufacturing E Construction G Retail Trade I Transport, Postal and Warehousing K- Financial and Insurance Services M Professional, Scientific and Technical Services O Public Administrative and Safety Q Health Care and Social Assistance B - Mining D Electricity, Gas, Water Services F Wholesale Trade H Accommodation and Food Services J Information Media and telecommunications L Rental, Hiring and Real Estate Services N Administrative and Support Services P- Education and Training R Arts and recreation Services S Other Services SECTION 4: CULTURAL BACKGROUND Are you of Aboriginal or Torres Strait Islander Origin? No Yes, Aboriginal Yes, Torres Strait Islander (Please mark both Yes boxes if you are of both Aboriginal and Torres Strait Islander origin). Were you born in Australia? YES NO If NO, what is your country of birth? Do you speak a language OTHER THAN English at home? YES NO If YES, which language do you usually speak? How well do you speak English? Very Well Well Not Well Not at all Do you need any language, literacy or numeracy assistance? YES NO Please note that upon receipt of this Application Form, NPT Heart will send through details of how to complete an online Language, Literacy and Numeracy (LLN) Assessment to ensure you have the required LLN competencies to complete the qualification for which you are wanting to enrol. SECTION 5: EDUCATION What is your highest COMPLETED school level? In which YEAR did you complete that school level Never attended school Year 8 or below Year 9 or equiv Year 10 or equiv Year 11 or equiv Year 12 or equiv Are you still attending secondary school YES NO 4
Have you SUCCESSFULLY completed any of the following qualifications? YES NO If Yes, please enter ALL of these Prior Education Achievement Recognition Identifiers for ANY applicable qualification level. A Australian E Australian equivalent I International Note: If you have multiple Prior Education Achievements Please use the same above codes to identify. 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 6: DISABILITY Do you consider yourself to have a disability, impairment or long term condition? YES NO If you indicated the presence of a disability, impairment or long term condition, please select the area(s) in the following list: (you may indicate more than one area) If you require assistance for a disability, please advise how we may assist you SECTION 7: STUDY REASON & LEARNING STYLE Hearing / Deaf Vision Physical Intellectual Learning Mental Illness Acquired Brain Impairment Medical Condition Other I have read the Course Brochure and am fully aware of and understand the learning and assessment requirements in order to achieve this qualification YES NO Of the following categories, which BEST describes your main reason for undertaking this course? (Tick ONE box only) To develop my existing skills To get a better job or promotion For personal interest or self-development To start a career in the industry It was a requirement of my job Other reasons (please specify) Indicate below your preferred learning style(s) (you may tick more than one). Participating in classes face to face with teacher and other students Group work with other students, discussion with other students Online completion of some units/subjects Self-directed tasks and activities Hands on tasks, role plays and activities Self-paced flexible learning workbooks On the job, workplace training and assessment 5
Briefly explain why you have chosen this particular course What do you hope to achieve from gaining this qualification What existing knowledge do you have of the Industry you are applying to study in? The industry requires a fair degree of manual handling activities (Refer to the Course Brochure for more information). Do you have any current or previous injuries that may prevent you from being able to undertake manual handling activities? Information Technology access and proficiency Computer Access Home Work None User Rating Novice Capable Advanced Internet Access Home Work None SECTION 8: SKILLS RECOGNITION Do you wish to apply for Credit Transfers? Credit Transfer is a process that provides credit for an equivalent unit of competency previously achieved. Do you wish to apply for RPL? Recognition of Prior Learning (RPL) is an assessment process that recognises the skills and knowledge you have already gained. If you have completed other courses, if you have relevant work experience and work-based training or life experience, you may be able to apply for credit for some or all of the units in the course you are applying for. YES NO If YES attach a certified copy of an academic record or statement of results for these courses / units of competency YES NO If YES please complete the employment history/work experience table below Note: RPL application fee is 75% of the applicable unit fee. Upon receipt of your application fee, you will sent an RPL pack for completion. EMPLOYMENT / WORK EXPERIENCE (only complete if applying for RPL) DATES POSITION COMPANY DUTIES HOURS / WEEK 6
SECTION 9: ELIGIBILITY FOR GOVERNMENT FUNDING (VICTORIAN SKILLS FIRST PROGRAM) All questions should be completed to enable NPT HEART to assess your eligibility to access Victorian Government Funding through the Skill First initiative. If any of the questions 4 to 6 in Section 9 are marked as Yes, you may not be eligible for Government Funding. If you believe you are eligible for an exemption, please contact NPT Heart who will help you through this process. If unsure please check your eligibility via the following link http://www.skills.vic.gov.au/victorianskillsgateway/students/pages/vtgeligibility-indicator.aspx 1. Are you: An Australian Citizen or A New Zealand Citizen or An Australian Permanent Resident or An Asylum Seeker Students must provide proof of his / her status proof can be an Australian birth certificate or Australian citizenship certificate or Current Australian or New Zealand passport of GREEN Medicare card. A copy of the VISA page of your passport is also valid proof to confirm status of any other formal Australian Department of immigration document to prove your status. A certified copy of the relevant document must be supplied with your Application. Note: if the document doesn t show the student s date of birth, then supplementary documents such as a current drivers licence, Proof of Age or Keypass card must be provided. Note: Asylum Seekers must provide a Referral Letter from the Asylum Seeker Resource Centre or the Australian Red Cross. YES NO 2. Do you reside in Victoria? YES NO 3. The highest qualification I have completed is: (include full title of qualification e.g. Certificate III in Aged Care) 4. Not including the course/s you are seeking to enrol in now, how many other government funded courses have you enrolled to undertake this year? Include training you are enrolled in to undertake at this and other training providers but not yet started 0 1 2 3 4+ (circle number) 5. Not including the course/s you are seeking to enrol in now, how many other government funded courses are you undertaking training in at the moment? 0 1 2 3 4+ (circle number) 6. In your life time, how many government funded courses have you started (commenced) that are at the same level as the one you are applying for now? 0 1 2 3 4+ (circle number) 7. Are you eligible for funding under the Latrobe Valley Initiative? If YES supply a certified copy of the Referral Letter issued by the Executive Director, Industry Engagement and VET Systems, Department of Education and Training. STUDENT DECLARATION YES NO I (Student s full name), in seeking to enrol in (qualification title i.e. Certificate III in Non-Emergency Patient Transport) Declare the following to be true and accurate statements: a) I AM / AM NOT enrolled in a school, including government, non-government, independent, Catholic or home school (circle appropriate response) b) I AM / AM NOT enrolled in the Commonwealth Government s Skills for Education and Employment program. (circle appropriate response) c) I understand that my enrolment in the above qualification/s may be subsidised by the Victorian and Commonwealth Governments under the Skills First Program. I understand how enrolling in the above qualification/s will affect my future training options and eligibility for further government subsidised training under the Skills First Program. d) I acknowledge and understand that I may be contacted by the Department or an agent to participate in a student survey, interview or other questionnaire. Signed: Date: 7
SECTION 10: STUDENT ENROLMENT PRIVACY NOTICE Victorian Government VET Student Enrolment Privacy Notice The Victorian Government, through the Department of Education and Training (the Department), develops, monitors and funds vocational education and training (VET) in Victoria. The Victorian Government is committed to ensuring that Victorians have access to appropriate and relevant VET services. Any personal information collected by the Department for VET purposes is protected in accordance with the Privacy and Data Protection Act 2014 (Vic) and the Health Records Act 2001 (Vic). Collection of your data NPT Heart Pty Ltd is required to provide the Department with student and training activity data. This includes personal information collected in the NPT Heart Pty Ltd enrolment form and unique identifiers such as the Victorian Student Number (VSN) and the Commonwealth s Unique Student Identifier (USI). NPT Heart Pty Ltd provides data to the Department in accordance with the Victorian VET Student Statistical Collection Guidelines, available at: http://www.education.vic.gov.au/training/providers/rto/pages/datacollection.aspx Use of your data The Department uses student and training data, including personal information, for a range of VET purposes including administration, monitoring and planning. A student s USI may be used for specific VET purposes including the verification of student data provided by NPT Heart Pty Ltd; the administration and audit of VET providers and programs; education-related policy and research purposes; and to assist in determining eligibility for training subsidies. Disclosure of your data As necessary and where lawful, the Department may disclose VET data, including personal information, to its contractors, other government agencies, professional bodies and/or other organisations for VET-related purposes. In particular, this includes disclosure of VET student and training data to the Commonwealth and the National Centre for Vocational Education Research (NCVER). Legal and Regulatory The Department s collection and handling of enrolment data and VSNs is authorised under the Education and Training Reform Act 2006 (Vic). The Department is also authorised to collect and handle USIs in accordance with the Student Identifiers Act 2014 (Cth) and the Student Identifiers Regulation 2014 (Cth). Survey participation You may be contacted to participate in a survey conducted by NCVER or a Department-endorsed project, audit or review relating to your training. This provides valuable feedback on the delivery of VET programs in Victoria. Consequences of not providing your information Failure to provide your personal information may mean that it is not possible for you to enrol in VET and/or to obtain a Victorian Government VET subsidy. Access, correction and complaints You have the right to seek access to or correction of your own personal information. You may also complain if you believe your privacy has been breached. For further information, please contact NPT Heart Pty Ltd s Privacy Officer, Narelle Greig, in the first instance by phone [03 8588 4833] or email [ngreig@nptgroup.com.au]. Further information For further information about the way the Department collects and handles personal information, including access, correction and complaints, go to: http://www.education.vic.gov.au/pages/privacypolicy.aspx For further information about Unique Student Identifiers, including access, correction and complaints, go to: http://www.usi.gov.au/students/pages/student-privacy.aspx I acknowledge that I have read the Victorian Government s VET Student Enrolment Privacy Notice. Student signature:. 8
SECTION 11: COURSE PAYMENT Note: payment will not be taken until a determination of your Pre-Training Review and the successful completion of the LLN Assessment. Course Application Fee: Full Fee paying student - $deposit fee as per Course Brochure Eligible for government subsidised training - $ administration and materials fee as per Course Brochure N/A to be covered by Employer - Employer Name: Payment Type Mastercard Visa Cheque Money Order EFT Credit Card No Expiry Date / Name on Card EFT Details Account Name: NPT Heart Pty Ltd BSB: 063151 Acc No 10544320 Signature Please put your FULL NAME against the Reference Details The deposit fee must be received to process the participant s enrolment into a course. Upon finalisation of the enrolment, the participant will be sent an invoice and statement of fees outlining all fees payable by the participant. Prior to the release of training materials, the participant must pay the applicable course fee or block fee. Please refer to the Course Brochure for full details of the Refund Policy. If NPT Heart cancels or fails to complete a course, the participant will be given the option of rescheduling the course without penalty or receiving a full refund. Participants who chose to not continue on with an alternative course date will be issued a statement of attainment for any units in which competency has been demonstrated. TERMS AND CONDITIONS The information you have provided will remain private and confidential. I give permission for NPT Heart Pty Ltd to discuss my training progress and results with my employer (if applicable), ASQA, Department of Education and other appropriate people as deemed necessary by NPT Heart. I give permission for NPT Heart to record evidence of my participation and assessment, in written, verbal, photographic (including video) formats. I also give permission for NPT Heart to use any recorded evidence for future promotional, commercial and educational purposes. I acknowledge that I have read the above and understand the information provided. I confirm that this information is true and correct. Signature Date 9
SECTION 12 : TRAINING AGREEMENT During the duration of this program, I understand and acknowledge that: My rights and obligations, as defined in the Participant Handbook include: 1. My obligation at all times to conduct myself safely and in adherence to all relevant legislation. 2. I will actively attempt all training and assessment tasks with serious effort. 3. That I will comply with all safe and lawful requests 4. I will arrive on time and will return on time from all breaks. 5. That I will not bully, abuse, vilify or fail to treat all people participating, associated with, or in the vicinity of NPT Heart training venues with the utmost respect and courtesy. 6. I will pay all fees outlined by the due dates and have no claim to be reimbursed for course fees if I fail to successfully complete any unit of this course NPT Heart s rights and obligations include: 7. Provision of quality assessment services in a competent manner through the provision of quality resources and staff. 8. Assessment will be performed by qualified assessors with the required knowledge and currency in the needs of industry. 9. Guaranteeing to provide assessment services to customers who have met their obligations with regard to completion of enrolment details, and financial payments 10. Guaranteeing that in the event that NPT Heart Pty Ltd cannot deliver a course unit, NPT Heart Pty Ltd will be refund the prescribed course unit cost to the purchaser. 11. Committing that training will not be offered to participants who fail to pay for the course. 12. Choosing to terminate a customer s training if they fail to uphold these standards Signature Date 10