Course Enrolment "*" indicates required fields Personal DetailsTitle* First Name* Middle Name Surname* Date of Birth* DD slash MM slash YYYY Gender* Male Female Phone Mobile* Email* Unique Student Identifier (USI) - If KnownIf 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 accordinglyBuilding / 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.Enrolment Details: Please select the preferred course* Certificate III in Individual Support (Ageing) Certificate III in Individual Support (Disability) Certificate III in Individual Support (Ageing & Disability) Certificate IV in Ageing Support Certificate IV in Disability Support Diploma of Community Services Diploma of Leadership and Management Advanced Diploma of Community Sector Management Provide Cardiopulmonary Resuscitation (CPR) Provide First Aid Provide First Aid in an Education and Care Setting General InformationHave you ever studied with QIE before?* Yes No City of Birth* Country of Birth* Do you speak a language other than English at home?*If more than one language, indicate the one that is spoken most often. No, English only Yes, other Please specify How well do you speak English?* Very well Well Not well Not at all Are you of Aboriginal or Torres Strait Islander origin?* No 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) Hearing/deaf Intellectual Mental illness Vision Physical Learning Acquired brain injury Medical condition Other None Please specify* What is your highest COMPLETED school* Year 12 or equivalent Year 11 or equivalent Never attended school – Go to question 11 In which YEAR did you complete that school level?* Are you still attending secondary school?* Yes No Are you an international student (subclass 500 visa)?* Yes No Previous QualificationsWhat 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 No Do you wish to apply for Recognition of Prior Learning?* Yes No EmploymentOf 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 ReasonOf the following categories, which BEST describes your main reason for undertaking this course?* To get a job I wanted extra skills for my job To develop my existing business To get into another course of study Next Of Kin/Emergency ContactName* Relationship To You* Address* Postcode* Mobile* Email* Privacy Statement and Student DeclarationI 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* DD slash MM slash YYYY Print Name*
