Program Enrolment Form

Program Enrolment Form
Program Name: Program Code:
Program Date: Name: Job Title:
Organisation Name: Phone:
Postal Address: Mobile: Delivery:
■ Distance
■ Face to Face
Conditions of Enrolment
All participants will receive email confirmation of their enrolment being processed by Transformed within 48 hours. Transformed will confirm whether advertised programs
will proceed ten business days prior to the commencement date (based on minimum enrolments being received).
Payment of program fees will be processed by Transformed ten business days prior to program commencement. 100% cancellation fee will apply for cancellations or nonattendance where at least ten business days written notice prior to program commencement is not received. Where more than ten days notice is received, a non refundable
administration fee of $50 will apply.
In the event of an illness (where a medical certificate is available), the participant may transfer to a future scheduled program date for the same program, or choose an
alternative program to the same value, without penalty. Where an invoice is issued, Transformed require settlement within 14 days.
How to enrol
FAX the completed enrolment form to (02) 6259 6223 or; Register online at
The information you provide remains confidential and is used for administration and program reporting. Transformed may use this information to notify you of future programs
and events. If you do not wish to receive this information tick this box
Payment Details
■ Invoice (PO number ■ Credit Card Payment:(Please provide credit card details below)
Card Type: ■ Visa
■ Mastercard
Card Number: Card Expiry Date: Total: Cardholders Name: ,
Cardholders Signature: Authorisation
I am authorised on behalf of my company to sign this registration form, and agree to the terms and conditions detailed above.
Print Name: Signature: Date: Additional Information
Please advise Transformed if we can assist you with any specific requirements or special needs, such as dietary/catering requests,
building access issues, interpreter requirements, classroom equipment etc.
please turn over to complete this form...
PO Box 7129 KALEEN ACT 2617
p: 02 6259 6221
f: 02 6259 6223
[email protected]
abn: 33 120 497 501
acn: 120 497 501
Employment Status
Which BEST describes your current employment status?
■ Full-time employee ■ Part-time employee ■ Employer ■ Self-employed ■ Employed (Unpaid family work) ■ Unemployed (Seeking full-time work) ■ Unemployed (Seeking part-time work) ■ Unemployed (Not seeking work)
Education History
■ No ■ Yes
What is your highest COMPLETED school level? ■ Year 12 ■ Year 11 ■ Year 10 ■ Lower
In which year did you complete that level? ■■■■
Have you successfully completed any of the following qualifications? ■ No ■ Yes, please specify
■ Bachelor or Higher Degree ■ Certificate I ■ Advanced Diploma ■ Certificate II
■ Diploma (or Associate Diploma) ■ Certificate III
■ Certificate IV (Or Advanced Certificate/Technician)
■ Qualifications other than listed (Please specify below)
Are you still attending secondary school?
Background Information
■ Yes ■ No, please specify Do you speak a language other than English at home? ■ No ■ Yes, please specify How well do you speak English? ■ Very Well ■ Well ■ Not Well ■ Not at All
Were you born in Australia?
Are you of Aboriginal or Torres Strait Islander origin? (For persons of both Aboriginal AND Torres Strait Islander, mark both)
■ No ■ Yes, Aboriginal ■ Yes, Torres Strait Islander
Do you consider yourself to have a disability, impairment or long-term condition?
■ Vision ■ Intellectual ■ Medical Condition ■ Hearing/Deaf ■ Learning ■ Acquired Brain Impairment ■ No ■ Yes, please specify
■ Physical ■ Mental Illness ■ Other Signature:
Under its national reporting obligations Transformed Pty Ltd is required to supply information collected on this form to State or Federal Government agencies for purposes of
research, statistics and program evaluations. By signing this form and attesting to the validity of the information supplied, you are agreeing to the supply of this information
for the stated purposes. No other disclosure will be made without your consent except as authorised or required by law. You have on request a right of access to personal
information we hold about you.
PO Box 7129 KALEEN ACT 2617
p: 02 6259 6221
f: 02 6259 6223
[email protected]
abn: 33 120 497 501
acn: 120 497 501