APPLICATION AND ENROLMENT FORM
It is a government requirement that Wodonga Institute of TAFE collects
and reports information related to your enrolment. For this reason it is
IMPORTANT that you complete this form accurately and in full.
STUDENT ID
YEAR
COURSE CODE
STUDY PERIOD
COURSE TITLE
LOCATION
UNIQUE STUDENT IDENTIFIER
From 1 January 2015, all Vocational Education and Training (VET) students in Australia must have a Unique Student Identifier (USI) to be issued
their qualifications. The USI will stay with the student for life and be recorded with any nationally recognised VET training that is completed
from when the USI comes into effect. The USI will be available online and at no cost to the student. You can apply now: www.usi.gov.au
Note: Wodonga TAFE cannot confirm your enrolment until a USI has been provided.
q I have applied for a USI, the number is ____ ____ ____ ____ ____ ____ ____ ____ ____ ____
q I have not applied but give Wodonga TAFE permission to apply on my behalf, a copy of one of the ID types below has been provided:
q Driver’s Licence q Medicare Card q Australian Passport q Visa (with Non-Australian Passport) q Citizenship Certificate q ImmiCard
PERSONAL DETAILS
q Mr q Miss q Mrs q Ms q Other____________________
Preferred Name __________________________________________
Surname ____________________________________________
Date of Birth _____ / _____ /_____
Given Names _________________________________________
q Female
ADDRESS OF USUAL PLACE OF RESIDENCE
MAILING ADDRESS (IF DIFFERENT)
q Male
No. and Street _________________________________________ No. and Street ______________________________________________
Town/Suburb _________________________________________
Town/Suburb ______________________________________________
State/Territory _________________ Post code ______________
State/Territory _________________ Post code ___________________
CONTACT DETAILS
Phone (H) ( ____ ) _________________________
q Preferred Mobile __________________________________
Phone (W) ( ____ ) ________________________
q Preferred Email _____________________________________________________
q Preferred
EMERGENCY DETAILS / NEXT OF KIN
Name _______________________________________________
Phone (H/W) ( ____ ) ________________________________________
Relationship _________________________________________
Mobile ____________________________________________________
CITIZENSHIP AND RESIDENCY, LANGUAGE AND CULTURAL DIVERSITY
Please select your citizenship status (proof of ID to be provided to an authorised representative of Wodonga TAFE)
q Australian Citizen q NZ Citizen q Australian Permanent Resident q Australian Permanent Humanitarian Visa q Temporary residents
In which country were you born? q Australia q Other (specify) _______________________ What year did you arrive in Australia? __________
Do you speak a language other than English at your home? q No, English only q Yes (indicate the one most spoken) __________________
How well do you speak English? q Very well q Well q Not well q Not at all
Are you of Aboriginal or Torres Strait Islander origin? q No q Aboriginal q Torres Strait Islander
STUDENT EDUCATIONAL BACKGROUND
SECONDARY SCHOOLING
Are you still attending secondary school? q No q Yes
What is your highest COMPLETED school level and the year you
completed it?
q Year 12 in _________ Post code at time of completion ________
q Year 11 in _________
q Year 10 in _________
q Year 9 or equivalent in _________
q Year 8 or lower in _________
q Did not go to school
PREVIOUS QUALIFICATION ACHIEVED
Have you SUCCESSFULLY COMPLETED any of the following qualifications? q No q Yes (you may tick more than one)
Please also indicate if it is an Australian (A), Equivalent Australian (E) or
International (I) qualification:
q Bachelor degree or higher
q Advanced Diploma or Associate Degree
q Diploma or Associate Diploma
q Certificate IV or Advanced Certificate/Technician
q Certificate III or Trade Certificate
q Certificate II
q Certificate I
q Certificates other than those above
qA
qA
qA
qA
qA
qA
qA
qA
q E
q E
q E
q E
q E
q E
q E
q E
q I
q I
q I
q I
q I
q I
q I
q I
The name of your highest Australian qualification indicated above is:
________________________________________________________
NISTC: 1800 667 778 OR [email protected] | DECA: 1300 365 400 OR [email protected]
VICTORIAN STUDENT NUMBER
Have you attended any Victorian school since 2009 or done any training with a vocational education and training (VET) registered
training organisation and/or Adult and Community Education provider in Victoria since 2011?
q No - I have not attended a Victorian school since 2009 or a TAFE or other VET training provider since the beginning of 2011.
Go to ‘CURRENT EMPLOYMENT STATUS’.
q Yes - I have attended a Victorian school since 2009. Name of most recent Victorian school:____________________________________
q Yes - I have participated in training at a Victorian VET provider 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)
1. ___________________________________ 2. ___________________________________ 3. ___________________________________
Please provide your Victorian Student Number (VSN): ___ ___ ___ ___ ___ ___ ___ ___ ___
CURRENT EMPLOYMENT STATUS
q Full time employee
q Self-employed
Not employing others
q Employer
q Part time employee
q Employed
Unpaid worker in family business
q Unemployed
Seeking full-time work
q Unemployed
Seeking part-time work
q Not employed
Not seeking employment
Which of the following classifications BEST describes your current or recent occupation? (Tick ONE box only).
q Managers
q Community and Personal Service Workers
q Technicians and Trade Workers
q Sales Workers
q Professionals
q Clerical and Administrative Workers
q Machinery Operators and Drivers
q Labourers
q Other
Which of the following classifications BEST describes the Industry of your current or previous employer? (Tick ONE box only).
q Electricity, Gas, Water and
Waste Services
q Professional, Scientific and
Technical Services
q Agriculture, Forestry and Fishing
q Rental, Hiring and Real
Estate Services
q Information Media and
Telecommunications
q Mining
q Accommodation and Food Services q Health Care and Social
Assistance
q Transport, Postal and Warehousing q Administrative and
Support Services
q Financial and Insurance Services
q Education and Training
q Construction
q Wholesale Trade
q Public Administration and Safety
q Manufacturing
q Retail Trade
q Arts and Recreation Services
q Other Services
DISABILITY DETAILS
Are you a person with disability, impairment or a long-term condition? q No q Yes, no assistance q Yes, assistance required
If YES, then please indicate the areas of disability, impairment or long-term condition? (you may indicate more than one area)
q Hearing q Physical q Intellectual q Learning q Mental illness q Acquired brain injury q Mobility q Vision q Medical
q Other (specify) __________________________________________________________________________________________________
PRE-TRAINING REVIEW
How are your core skills?
These skills are important for effective communication and for
thinking critically about new information and ideas.
Rate your skills from 1 (= very poor) to 5 (= excellent).
How are your employability/work skills?
These skills are important for obtaining and retaining jobs.
Rate your skills from 1 (= very poor) to 5 (= excellent).
Learning - setting goals and managing your own learning
Communication - speaking, listening, reading, writing, numeracy
Reading - understanding written text, word identification and vocabulary
Teamwork - working in groups, giving feedback
Writing - expressing ideas, opinions, factual information or messages
in writing
Problem solving - working out ways to do things
Oral communication - using speaking and listening skills in interpersonal
and transactional exchanges
Numeracy - understanding and applying mathematical ideas
and techniques
Initiative and enterprise - trying new things, being creative
Planning and organising - making decisions, organising things
Self-management - taking responsibility, organising yourself
Technology - using computers, machines, mobile phones
STUDY REASON
Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship?
q Find a job
q Develop my existing
business
q Start my own business
q Start a different career
q Find a better job or promotion
q Requirement of
my job
q Want extra skills for my job
q Enter a different course
of study
q Personal interest or
self-development
q Other reasons
CREDIT CARD
If you are not paying in person you can provide payment details
here. All credit card details are blocked out once the financial
transaction has been processed.
q Mastercard q VISA
Card Number ___________________________________________
Expiry Date _______ / _______
Verification Code ___________
Card holder’s name ______________________________________
Signature _____________________________________________
q Please call for credit card details for payment
PRIVACY STATEMENT AND STUDENT DECLARATION
I understand that Wodonga Institute of TAFE (WIOT) is required to provide the Victorian Government, through the Department of Education
and Early Childhood Development, with student and training activity data which may include information I provide in this enrolment form.
Information is required to be provided in accordance with the Victorian VET Student Statistical Collection Guidelines (which are available at
http://www.education.vic.gov.au/training/providers/rto/Pages/datacollection.aspx). The Department may use the information provided to it for
planning, administration, policy development, program evaluation, resource allocation, reporting and/or research activities. For these and other
lawful purposes, the Department may also disclose information to its consultants, advisers, other government agencies, professional bodies
and/or other organisations. However, the personal details of individuals held by the Student Identifiers Register will be protected by the Privacy
Act 1988 (CTH). I have been advised by the training organisation that I may be contacted and requested to participate in a National Centre for
Vocational Education Research survey or a Department-endorsed project or audit or review. The Education and Training Reform Act 2006 requires
WIOT to collect and disclose my personal information for a number of purposes including the allocation to me of a Victorian Student Number
and updating my personal information on the Victorian Student Register. WIOT is also obliged to provide information when requested to other
government agencies, including Centrelink.
For students eligible for VET FEE-HELP, the following privacy statement also applies:
WIOT is collecting the information in this form for the purpose of assessing my entitlement to Commonwealth assistance under the Higher
Education Support Act 2003 and allocation of a Commonwealth Higher Education Student Support Number (CHESSN) to me. WIOT will disclose
this information to the Commonwealth Department of Industry, Innovation, Science, Research and Tertiary Education (DIISRTE) for those
purposes. DIISRTE will store the information securely in the Higher Education Information Management System. DIISRTE may disclose the
information to the Australian Taxation Office. WIOT and DIISRTE will not otherwise disclose the information without my consent unless required or
authorised by law.
Acknowledgment and agreement
I acknowledge and agree to the terms described in this privacy statement. For more information in relation to how student details may be used or
disclosed contact WIOT’s Privacy Officer, on (02) 6055 6600 or email [email protected] or by writing to The Privacy Officer,
Wodonga TAFE, PO Box 963, Wodonga VIC 3689.
• I agree to be bound by all WIOT rules and regulations and to abide by the WIOT Student Charter.
• I agree to pay all fees and charges applicable to, and arising from, this enrolment (please refer to Fees, Charges and Refund flyer).
• While WIOT will endeavour to run all courses and classes as promoted, I acknowledge the right of WIOT to cancel or amalgamate classes if
necessary.
• I authorise WIOT, or its agent, in the event of illness or accident during any Institute-organised activity, and where next of kin cannot be
contacted within reasonable time, to seek ambulance, medical or surgical treatment at my cost.
• I also authorise WIOT to release information to state and commonwealth government departments, and/or apprenticeship authorities (if
requested).
• I acknowledge that providing any false information and/or failing to disclose any information relevant to my application for enrolment and/or
failure to complete an application/enrolment form may result in the withdrawal of any offer, particularly as it relates to my eligibility to obtain
an offer for government subsided training, and/or cancellation of enrolment at the discretion of WIOT.
• I understand that it is my responsibility to provide all relevant and required documentation.
• I authorise WIOT to check all available records to confirm that information provided is correct, particularly information pertaining to my
eligibility for the Victorian Training Guarantee.
DRUGS AND ALCOHOL
NISTC and DECA strive to provide a safe training environment and considers the abuse of drugs or alcohol to be unsafe and dangerous. Any
student suspected to have alcohol or illegal drugs in his/her system will be refused training.
By signing below I declare that I am alcohol and drug free.
STUDENT SIGNATURE _____________________________________________
DATE____ /____ / ____
WIOT STAFF USE ONLY
IDENTIFICATION AND CONCESSION CONFIRMATION
Proof of ID provided q Sighted q Verified copy sighted q Employer verified
Signed: ___________________________________
Eligible for a concession q No q Yes ( q HCC q Pension q VGC)
Evidence of concession retained: q Physical card q Digital wallet q Centrelink e-Confirmation
COURSE #1 DETAILS
COURSE #2 DETAILS
Code ________________________________________________
Code _____________________________________________________
Title _________________________________________________
Title ______________________________________________________
Location ________________________
Location ________________________
Year __________ Study Pd ___________________ Av # _______
Year __________ Study Pd _____________________ Av # _______
Template # ____________________________________________
Template # ____________________________________________
ENROLMENT CENTRE USE ONLY
Course commencement date: _____ / _____ / _____
Course commencement date: _____ / _____ / _____
Liability Category ______ q VTG paperwork attached (if applicable)
Liability Category ________
Tuition
$ ___________
Tuition
$ ___________
Materials
$ ___________
Materials
$ ___________
Other
$ ___________
Other
$ ___________
TOTAL
$ ___________
TOTAL
$ ___________
q VTG paperwork attached (if applicable)
FEES AND CHARGES SUMMARY
Course # 1
$ ___________
Course # 2
$ ___________
Direct Debit Fee
$ ___________
TOTAL PAYABLE
$ ___________
Invoice #
_____________
q ST q SP _______________
P/Order # _________________
MOU/TRIM # ______________
Processed by:
_____________________ Date: ____ / ____ / ____
q CF037 Fee Waiver
q KF006 Internal transfer
AMOUNT PAID
$ ___________
Receipt #
_____________
q Cash q Cheque q EFTPOS
Processed by:
_____________________ Date: ____ / ____ / ____
REMAINING FEES
$ ___________
q Direct Debit q Centre Pay q VET FEE HELP
MAILING ADDRESSES FOR NISTC/DECA LOCATIONS
ALTONA PO Box 1063, Altona Gate, VIC 3025
CARRUM DOWNS PO Box 4036, Dandenong South, VIC 3164
NEWBOROUGH PO Box 327 Newborough, VIC 3825
PUCKAPUNYAL PO Box 1, Milpo Puckapunyal, VIC 3662
SHEPPARTON PO Box 1742, Shepparton, VIC 3632
WODONGA PO Box 963, Wodonga, VIC 3689
TASMANIA PO Box 824, Moonah, TAS 7009
NSW PO Box 207, Quakers Hill, NSW 2763
VERSION 23. 2292_DECEMBER_2014