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Australian Centre of Further Education
Work Training Program for Nurses (WTPN)
STUDENT APPLICATION FORM
Personal Details
1. Surname:
2. Given Name:
3. Middle Name/s:
4. Title: Mr.
5. Marital Status:
Mrs.
Miss
Ms.
Single
Married
Divorced
6. Is this your legal name?
Yes
Dr.
Separated
Widow/Widower
If not, what is your
legal name?
No
8. Sex : Male
7. Date of birth (dd/mm/yyyy)
9. Home Phone:
Other
Female
10.Mobile Phone:
11. E-mail:
12. Address in Australia
Flat/Unit
Number:
Building/
Property Name:
Street Number:
(e.g. 5 or lot 12)
Street
Name:
Suburb,
Locality or Town:
State /
Territory:
Postcode:
13. Emergency Contact
Name
Relationship to you
Phone
E-mail
Australian Centre of Further Education Pty Ltd
Phone: (03) 8600 8600 | Fax: (03) 9670 0454 | Email: [email protected] | Website: acfe.edu.au
Level 5/341 Queen Street, Melbourne VIC 3000, Australia
ABN: 37 135 002 167 | ACN: 135 002 167 | RTO Code: 40898 | Cricos# 03377J
WTPN Application Form 1.1
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Programs
Please tick applicable items:
PROGRAM 1 (12 months including IRON Program)
PROGRAM 2 (9 months)
Application Process
The Student Application Form is completed and submitted to Australian Centre of Further Education (ACFE ) with supporting
documents (Minimum Requirement for Enrolment)
Application Requirements
Documents Required to Submit this
Application Form
1. For Program 2 applicants only: Australian Health
Practitioner Regulation Agency (AHPRA) Registration.
Student must provide an original certified true copy
of the AHPRA Registration. This registration must
be Valid. (A valid letter is 12 months from the date of
issue)
2. Current Working with Children check (Victoria) or
interstate equivalent.
3. Supporting documents Please attach an up to date
resume
4. Professional Indemnity Insurance
Additional Documents Required when accepted in
the Program
5. Applicants must provide certified copies of all relevant
information of nursing registration, and other nursing
courses.
6. POLICE CLEARANCE: Students must provide a certified
copy of a Police Clearance certificate from country of Origin.
7. On shore applicants must have a current working with
children check (Victoria) or interstate equivalent.
8. IMMUNIZATION: Students need to provide evidence of
Immunisation for Hepatitis B, Pertussis, Diphtheria, Tetanus,
Measles, Mumps, Rubella, Annual Influenza vaccination,
Mantoux and clear X-ray for Tuberculosis.
9. Bio Data Page of Passport
Course Fee And Refund Policy
1. Fee is required together with a completed ACFE Application Form
PROGRAM 1 (12 months including
IRON Program)
Application Fee
Course Fee
Initial Fee
A$200.00
A$20,000.00
$10,000 is required within 7 days
of receiving the Letter of Offer and
Confirmation of Work Training
Sponsorship
Discount
Australian Centre of Further Education Pty Ltd
Phone: (03) 8600 8600 | Fax: (03) 9670 0454 | Email: [email protected] | Website: acfe.edu.au
Level 5/341 Queen Street, Melbourne VIC 3000, Australia
ABN: 37 135 002 167 | ACN: 135 002 167 | RTO Code: 40898 | Cricos# 03377J
WTPN Application Form 1.1
PROGRAM 2 (9 months)
A$200.00
A$10,000.00
$5,000 is required within 7 days of
receiving the Letter of Confirmation
of Work Training Sponsorship
ACFE IRON Program graduates
are entitled to $2000 discount if
enrolled in the full Program 2
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2. Refunds
a. Full Refund is applicable only to Offshore Applicants if the 402 Visa is denied.
b. No Refund applicable to onshore applicants if withdrawn from the WTPN upon 402 Visa lodgement.
Note:
All students must refer and read the “SM25-Fees Charges and Refund Policy Document” located on the ACFE website by
clicking on the following link: SM25-Fees-Charges-and-Refunds-Policy-V1.3.pdf
“I have read, understood and accept the SM25-Refund Policy pdf
on your website.”
Payment or participation in the program does not guarantee recommendation or registration with the Nursing and Midwifery
Board of Australia (NMBA) within the Registered Nurse section of the AHPRA register, this requires successful completion of
the program.
Student Declaration
In signing this form I agree:
• That the information I have provided on this form is true, correct and complete;
• To be bound by the applicable standards of conduct , statutes, regulations , policies and procedures of Australian Centre
of Further Education including any variations that are made from time to time
• I read and accept the “Fees, Charges and Refund Policy” of the Australian Centre of Further Education
• I understand that failure to comply with any of the above may result in being unable to register as Registered Nurse in
Australia with AHPRA
Student Signature
Date
How to lodge this form
Please return this Form along with supporting documents to:
The Administrator
Australian Centre of Further Education Pty Ltd.
Level 5, 341 Queen Street. Melbourne 3000 AUSTRALIA
Tel: +613 8600 8600 | Fax: +613 9670 0454 | Email: [email protected]
Australian Centre of Further Education Pty Ltd
Phone: (03) 8600 8600 | Fax: (03) 9670 0454 | Email: [email protected] | Website: acfe.edu.au
Level 5/341 Queen Street, Melbourne VIC 3000, Australia
ABN: 37 135 002 167 | ACN: 135 002 167 | RTO Code: 40898 | Cricos# 03377J
WTPN Application Form 1.1
Page 3/4
STUDENT FEE PAYMENT ADVICE
PERSONAL DETAILS
Surname:
Given Name:
Middle Name/s:
Title: Mr.
Mrs.
Miss
Ms.
Dr.
Other
Address
Postcode
Home Phone
Work Phone
Mobile
Email
PAYMENT DETAILS
MODE OF PAYMENT (please tick)
VISA
MASTER CARD
CASH
BANK CHEQUE
EFT
(A) CREDIT CARD ALL VISA AND MASTERCARD TRANSACTIONS WILL INCUR A 2.5% ADDITIONAL FEE.
Card Number
Card Holder Name
Card Holder’s Signature
VERIFICATION CODE (last
3 digits on back of card)
EXPIRY DATE
(B) ELECTRONIC FUNDS TRANSFER (EFT)
Account Name: Australian Centre of Further Education Swift code: NATAAU3303M
BSB: 083 091
Account Number: 94-385-6373
Bank Details: National Australia Bank Bank Address: 460 Collins St., Melbourne, VIC 3000 Australia
Please include the Student name in the description box, so we are able to identify payment allocation.
Please allow extra for Bank transfer fees.
Australian Centre of Further Education Pty Ltd
Phone: (03) 8600 8600 | Fax: (03) 9670 0454 | Email: [email protected] | Website: acfe.edu.au
Level 5/341 Queen Street, Melbourne VIC 3000, Australia
ABN: 37 135 002 167 | ACN: 135 002 167 | RTO Code: 40898 | Cricos# 03377J
WTPN Application Form 1.1
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