Student Application View Courses Enrol Now Student Application Form 1. STUDENT DETAILSTitle* Mr Mrs Ms Miss Gender*Choose OptionMaleFemaleOtherDate of Birth* DD dash MM dash YYYY Given Name*Surname*Home Phone*Mobile*Address* Street Address City State / Province / Region ZIP / Postal Code Email Address* Preferred method of contact* Email Phone SMS 2. TRAINING PROGRAM DETAILSProgram Code*Program Cost*Program Name*Learning Pathway* Training and Assessment Assessment Only VOC Start Date* DD slash MM slash YYYY End Date* DD slash MM slash YYYY Delivery Mode* Classroom Work Based 3. UNIQUE STUDENT IDENTIFIER (USI)USI No*If you do not have a USI do you give Integral Skills permission to apply for one on your behalf?* Yes No To raise a USI we will need one of the following proof of Identity evidences.*Drivers Licence NoExpiry DateState of IssueTo raise a USI we will need one of the following proof of Identity evidences.*Medicare Card NoExpiry DateRef NoName on Card*4. CULTURAL DIVERSITY AND CITIZENSHIPAre you of Aboriginal or Torres Strait Islander Origin?* No Yes - Aboriginal Yes – Torres Strait Islander Are you and Australian or New Zealand Citizen?* Yes No What country were you born in?5. EMPLOYMENT STATUSWhat is your Employment Status?* Full Time employee Part time employee Self-employed (not employing others) Employer Employed – unpaid worker in family business Unemployed seeking full time work Unemployed seeking part time work Unemployed not seeking employment 6. LANGUAGEDo you speak a language other than English at home?* No – English only Yes Other LanguageHow well do you speak English?* Very well Well Not well Not at all 7. DISABILITYDo you have a disability?* Yes No Please state your disability, impairment or injury* Hearing ntellectual Physical Learning Mental Illness Acquired 8. PRIOR EDUCATIONWhat is your highest level of school completed?* Year 9 or lower Year 10 Year 11 Year 12 In which year did you complete school?* DD slash MM slash YYYY Have you successfully completed any of the following qualifications?* Yes No Qualifications* Bachelor’s degree or Higher Degree Advanced Diploma or Associate Degree Diploma or Associate Diploma Certificate IV or Advance Certificate Certificate III or Trade Certificate Certificate II Certificate I Certificates - other Do you wish to apply for Recognition of Prior Learning or Credit Transfer?* Yes No Have you completed the Higher School Certificate (Y12 / HSC)?* Yes No Do you consider that you have the literacy and numeracy skills to undertake the course?* Yes No Have you completed a prior nationally recognised training in Australia at least to the level of Certificate III?* Yes No Do you identify as having any individual support needs that we can assist you with during your training?* Yes No 9. REASON FOR STUDYReason For Study?* To get a job or better job It was a requirement of my job To develop my existing business To try for a different career To start my own business For personal interest or self-development I want extra skills for my job Other 10. EMERGENCY CONTACTNameRelationshipHome PhoneMobile11. MARKETING AND IMAGESHow did you hear about us?* Existing Client Consultant Internet Employer Other Integral Skills may from time to time send you details about future training opportunities or offers. If you DO NOT wish to be contacted, please indicate below.* I do not wish to be contacted regarding future training opportunities. During training, photos or footage may be taken of you. Do you give Integral Skills permission to use these photos or footage for such things as improving training resources, promotional documents and reports?* Yes No 12. STUDENT DECLARATIONBy signing this form, I certify that the information provided is true and correct. I further certify that:* I have reviewed the Learner Handbook supplied to me and have been informed about and accept my rights and obligations. * I have reviewed and accept the Schedule of Fees and Payments and have been informed of the refund policy. * I have reviewed the Course Brochure and have been informed of and accept the training and assessment services to be provided and the units of competency to be completed. * I have reviewed the National VET Data Privacy Policy notice provided in the Learner Handbook and acknowledge that Commonwealth and State or Territory government departments and authorised agencies will use my personal information in accordance with this notice. SignatureDate MM slash DD slash YYYY
