Course Enrolment

Enrolment Form

"*" indicates required fields

Personal Details

Title*

First Name*

Middle Name

Surname*

Date of Birth*

Gender*

Male

Female

Phone

Mobile*

Email*

Unique Student Identifier (USI) - If Known

If you do not yet have a USI and want QIE to apply for a USI on your behalf, complete the declaration at the end of the form.

Please provide your postal address in the boxes below accordingly

Building / Property Name*

Flat/Unit Number*

Street or Lot number*

Street Name*

Suburb, Locality, or Town*

State/Territory*

Postcode*

*What is the address of your usual residence?

Please provide the physical address (street number and name not post-office box) where you usually reside rather than any temporary address at which you reside for training, work, or other purposes before returning to your home. If you are from a rural area, use the address from your state’s or territory’s ‘rural property addressing’ or ‘numbering’ system as your residential street address.

Courses

Enrolment Details: Please select the preferred course

CHC33021 Certificate III in Individual Support (Ageing)

CHC33021 Certificate III in Individual Support (Disability)

CHC33021 Certificate III in Individual Support(Ageing & Disability)

CHC43015 Certificate IV in Ageing Support

CHC43015 Certificate IV in Disability Support

BSB50420 Diploma of Leadership and Management

CHC52021 Diploma of Community Services

CHC62015 Advanced Diploma of Community Sector Management

First Aid Courses / Unit of Competency

Enrolment Details for Fast Aid Courses: Please select the preferred course

HLTAID009 Provide cardiopulmonary resuscitation (CPR)

HLTAID011 Provide First Aid

HLTAID012 Provide First Aid in an education and care setting

HLTAID014 Provide Advanced First Aid

Professional Development Courses

Enrolment Details for professional Development courses: Please select the preferred course

Manual Handling

Professional Development

Preferred start date:*

General Information

Have you ever studied with QIE before?*

Yes

City of Birth*

Country of Birth*

Nationality*

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

No, English only

Other

If more than one language, indicate the one that is spoken most often.

How well do you speak English?*

Very well

Well

Not well

Not at all

Are you of Aboriginal or Torres Strait Islander origin?*

Yes, Aboriginal

Yes, Torres Strait Islander

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

If yes, please indicate the area of disability, impairment or long-term condition. (tick as many as apply)

Please specify*

What is your highest COMPLETED school*

Year 12 or equivalent

Year 11 or equivalent

Year 10 or equivalent

Year 9 or equivalent

Year 8 or below

Never attended school – Go to question 11

In which YEAR did you complete that school level?*

Are you still enrolled in secondary or senior secondary education*

Yes

Previous Qualifications

Have you successfully completed any of the qualifications listed below?*

Yes

If YES, tick ANY applicable boxes*

Bachelor degree or higher degree

Advanced diploma or associate degree

Diploma (or associate diploma)

Certificate IV (or advanced certificate/technician) 511

Certificate III (or trade certificate)

Certificate II

Certificate I

Other education (including certificates or overseas qualifications not listed here) 990

Are you an international student (subclass 500 visa)?*

Yes

What is your most recent qualification?*

Do you wish to apply for National Recognition or Credit Transfers? If YES, certified copies of transcripts from previous qualifications must be provided*

Yes

Do you wish to apply for Recognition of Prior Learning?*

Yes

Employment

Of the following categories, which BEST describes your current employment status?*

Full-time employee

Employed – unpaid worker in a family business

Part-time employee

Unemployed – seeking full-time work

Self-employed – not employing others

Unemployed – seeking part-time work

Employer

Not employed – not seeking employment

Study Reason

Of the following categories, which BEST describes your main reason for undertaking this course?*

Next Of Kin/Emergency Contact

Name*

Relationship To You*

Address*

Postcode*

Mobile*

Email*

Picture and Valid ID Proof

Please Upload Your Picture*

Max. file size: 2 MB.

Please Upload Your Valid ID Proof*

Drop files here or

Max. file size: 1 MB, Max. files: 2.

Privacy Statement and Student Declaration

I declare that the information I have provided is true and correct. I am aware of the consequences that may arise from providing false, misleading or incomplete information, including the cancellation of my enrolment or the withdrawal of any offer made by Quest Institute of Education.

I understand that my RTO [Quest Institute of Education] is required to submit data sourced from this enrolment form to the national VET administrative collection as a regulatory reporting requirement. The information contained on my enrolment form may be used by my RTO or the following third parties for administrative, regulatory and/or research purposes:

Government departments and agencies and authorised VET related bodies.
VET regulators.

If you would like us [Quest Institute of Education] to apply for a USI on your behalf you must authorise us to do so and declare that you have read the privacy information at http://www.usi.gov.au/Training-Organisations/Pages/Privacy-Notice.aspx. You must also provide some additional information as noted at the end of this form so that we can apply for a USI on your behalf.

I authorise Quest Institute of Education to apply pursuant to sub-section 9 (2) of the Student Identifiers Act 2014, for a USI on my behalf.

I have read and I consent to the collection, use and disclosure of my personal information pursuant to the information detailed at http://www.usi.gov.au/Training-Organisations/Pages/Privacy-Notice.aspx
I understand that I may receive a National Centre for Vocational Education Research (NCVER) student survey.
I confirm that I am not a Subclass 500 (International Student) visa holder.

Date*

Print Name*

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