Enrolment









 

Enrolment Form

 

Course Name & Code:
Course Start Date: Course Provider:

Do you plan to apply for Recognition of Prior Learning (RPL) or Credit Transfer?

Yes No

 Are you Funded for this course? Yes No

If yes, Funding Source:
Personal Details
Title: Sex: Please make a selection.
Family Name
Please enter your Last Name.		 First Name
Please enter your First Name.
Former Family Name: ( if applicable )
Date of Birth Please enter your Date of Birth.

Home Address

 

Postal Address
( if different from home address )
State State
Postcode Postcode
Telephone
(day)
Please enter a Day Time Phone number.		 Telephone
(work)
Mobile Email
Employment Status
Of the following categories, which BEST describes your CURRENT employment status?







Employer Details
Is your training funded by your employer? Yes No
If Yes, please provide employer details below:
Name of supervisor
Company name
Address
Telephone Email
Highest completed school level





In what year did you complete that school level?
Have you successfully completed any of the following qualifications?
Tick more than one if applicable

Postgraduate Degree level

Bachelor Degree or higher

Diploma (or Associate Diploma)

Certificate III (or Trade Certificate)

Certificate I

Graduate Diploma or Certificate

Advanced Diploma (or Associate Degree)

Certificate IV (or Advanced Certificate)

Certificate II

Certificates other than above

Which BEST describes your MAIN REASON for undertaking this course?
Select one box only

To get a job

To develop my existing business

To start my own business

To try for a different career

For personal interest

Other reasons

To get a better job or promotion

It was a requirement of my job

I wanted extra skills for my job

To get into another course of study

For self- development

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 - please specify
If yes, how well do you speak English?
Very well Well Not well Not at all
Are you an Australian Citizen?
Yes No
If no, are you a Permanent Australian Resident?
Yes – date of Permanent Residency
No  
In which country were you born?
Australia Other - please specify
Are you Aboriginal or Torres Strait Islander?



Do you consider yourself to have a disability, impairment or long term condition?
Yes No  

If yes, please indicate the areas of disability, impairment or long term condition:

(You may indicate more than one area)

Hearing/Deaf

Physical

Intellectual

Vision

Other - please specify

Learning

Mental Illness

Acquired Brain Impairment

Medical Condition

Do you have any needs of which the trainer needs to be aware that may impair or have impact on your learning?

For example: language difficulty, distance from training location

Yes No Not applicable

If Yes, please specify
Previous study with ITCC or University of Wollongong
Have you previously studied at ITCC (International Training & Careers College), UOW College (formerly Wollongong College Australia) or UoW (University of Wollongong)?
Yes No  
If yes, please supply details below:  
ITCC UOW College UoW  
Course Name
Student number