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
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