Online Enrolment Form

Please complete the questions below:

Name

If you do not have our Learner Handbook, please click on the link below to download a copy

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Your course *

PERSONAL DETAILS

Please complete the following information:

Are you living in Australia on a visa? (Tick NO if you are an NZ Special Category Visa Holder) *

Yes No

Do you have a USI (Unique Student Identifier) *

Yes No

If you have been given an Enrolment Code, please enter it below

Please provide your proper full name below as it will be printed on your Statement of Attainment

Title *

First name *

Middle name(s) *

Surname *

Please provide the preferred name you would like us to use when engaging with you

Preferred name (optional)

Gender *

Date of birth *

Town of birth *

Country of birth *

Mobile *

Landline phone

Email *

RESIDENTIAL ADDRESS

Building name

Flat/unit details

Street/Lot number *

Street name *

Suburb *

State/Territory *

Postcode *

Country *

POSTAL ADDRESS:

(if different from residential address above)

Building name

Flat/unit details

Street/Lot number/PO Box

Street name

Suburb

State/Territory

Postcode

Country

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STATISTICAL INFORMATION

As a Registered Training Organisation, we are required to collect the following information for government statistical purposes.

Of the following categories, which best describes your current employment status? (Choose one) *

What is your highest completed school level? (Choose one) *

In which year did you complete that school level? *

Are you still attending secondary school? *

Yes No

Have you successfully completed any of the following qualifications? (Choose any that apply) *

No Certificate I Certificate II Certificate III Certificate IV Certificate V Certificate VI Certificate VII Diploma level Advanced diploma or associate degree level Bachelor degree or higher degree level (defined for AVETMISS use only) Miscellaneous education

Do you speak a language other than English at home? *

No, English only Yes, please specify language(s)

Do you consider yourself to have a disability, impairment or long-term condition? *

Yes No

Of the following categories, which best describes your main reason for undertaking this course? (Choose one)

Are you of Aboriginal or Torres Strait Islander origin? (Choose one)

(OPTIONAL) WORK HISTORY

Please briefly tell us about yourself

Current employment

Current qualifications

Work experience (The 2 most recent organisations you worked in and your role there)

LEARNER ACKNOWLEDGEMENT AND DECLARATION

The information provided by me in this ENROLMENT FORM is true and correct.

I have read and understood the information contained in this ENROLMENT FORM, the REFUND POLICY and the LEARNER HANDBOOK

I have read and understood the information contained in this ENROLMENT FORM, the REFUND POLICY and the LEARNER HANDBOOK.

I consent and authorise Validum Institute to manage any personal information I have provided in the manner described in Validum's PRIVACY POLICY, and the LEARNER HANDBOOK and in particular to verify my identity or my USI.

By typing my name in the space below, I declare that I have read and understood the PRIVACY POLICY, the REFUND POLICY and ENROLMENT TERMS AND CONDITIONS in the LEARNER HANDBOOK and agree that, on acceptance of my enrolment by Validum Institute, the provisions of the PRIVACY POLICY, the REFUND POLICY, the LEARNER HANDBOOK and the ENROLMENT TERMS AND CONDITIONS will govern my relationship with Validum Institute.

Sign Name

Date

PERSONAL DETAILS

RESIDENTIAL ADDRESS

POSTAL ADDRESS:

STATISTICAL INFORMATION

(OPTIONAL) WORK HISTORY

LEARNER ACKNOWLEDGEMENT AND DECLARATION

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