2015 Enrolment Form v1 - Wyndham Community & Education

Third party details (if applicable)
 JSA (Job Service Agency)
Organisation name: _______________________________________________
 Insurance Company
Contact name: ___________________________________________________
 WorkCover
Contact Phone and/or Email: ________________________________________
 Other
I authorise Wyndham CEC to give details of my course enrolment and progress to this organisation
Student Enrolment Form
RTO ID 4179
Signature: _______________________________________________________ Date: ____________________
Payment options:
 The above third party is also paying the course fees
3 Princes Highway, Werribee 3030
Telephone: (03) 9742 4013 Fax: (03) 9749 8400
Email: [email protected]
ABN: 19 380 206 291
Association No: A0002509M
 The fees are being paid by me
Conditions of Enrolment: Fees for the relevant year are due upon the commencement of a course. Places
cannot be held if payment has not been received. Concessions: Wyndham CEC need to take a copy of your
concession card for a concession fee to be approved. Refunds: Courses with insufficient enrolments may be
cancelled. In this instance all fees paid will be fully refunded.
If a client wishes to withdraw from a ‘fee for service course’, we require 5 working days notice prior to the
commencement of the course. A refund will be made less a $50 administration fee. If less than 5 days notice is
given no refund is allowed. No refunds are given after a course starts.
If you are enrolled in a government subsidised course we require written notice up until 4 weeks after
commencement of course. A refund will then be made. Please see our Concessions, Fees, Charges and
Refunds Policy for full details. Information on this policy and other policies pertaining to students is available on
our website under the heading Information, Policies & Procedures.
Staff initials:
VETtrak code:
Course Name:
Course Code:
RNA entered on VETtrak:
Funding source:
Student enrolment privacy notice.
I understand that Wyndham Community and Education Centre is required to provide the Victorian Government,
through the Department of Education and Early Childhood Development, with student and training activity data which
may include information I provide in this enrolment form. Information is required to be provided in accordance with the
Victorian VET Student Statistical Collection Guidelines (which are available at http://www.education.vic.gov.au/
training/providers/rto/Pages/datacollection.aspx). The Department may use the information provided to it for planning,
administration, policy development, program evaluation, resource allocation, reporting and/or research activities. For
these and other lawful purposes, the Department may also disclose information to its consultants, advisers, other
government agencies, professional bodies and/or other organisations. I have been advised by the training
organisation that I may be contacted and requested to participate in a National Centre for Vocational Education
Research survey or a Department-endorsed project or audit or review.
The Education and Training Reform Act 2006 requires Wyndham Community and Education Centre to collect
and disclose my personal information for a number of purposes including the allocation to me of a Victorian
Student Number and updating my personal information on the Victorian Student Register.
For more information in relation to how student information may be used or disclosed please contact Wyndham
Community and Education Centre's Privacy Officer on phone 9742 4013 or email [email protected]
Tuition fee:
Amenities Fee:
Resource Cost:
The following information is required by organisations receiving Government funds. Please answer every question
on this form. Thank you for your cooperation and assistance.
Enter your full name
Surname (Legal Family Name)
Given names (Legal Given Names)
I acknowledge and agree to the terms described in this privacy statement:
Of the following categories, which BEST describes your main reason for undertaking this course?
(Tick one box only)
Student signature:___________________________________________________ Date:________________
Parent/guardian signature:____________________________________________ Date:________________
(if student under 18 years old)
All students: I agree to abide by this Centre's policies regarding student rights and responsibilities and I
acknowledge, by signing this form, that all information provided in it is accurate.
It was a requirement of my job
I wanted extra skills for my job
To start my own business
To get into another course of study
To try for a different career
For personal interest or self development
Other reasons
Do you qualify for a concession?
If yes, please tick what type.
Health Care Card (H)
Pensioner Concession Card (P)
Job seeker concession card holder (J) *
Jobseeker & NOT concession card holder (K)*
Veteran Gold Card Concession (V)
Other (O)
* Need Job Seeker Referral Form
Opt out options:
Enter your birth date: Day/Month/Year
 Electronic account creation
Sex (tick one box only):
 Direct marketing
Home phone: 0 3
From time to time Wyndham CEC may contact you to offer you upgrades to your qualification or other relevant courses. Wyndham CEC may use the information
contained in this form to contact you. If you would like to opt out of direct marketing please check this box. Your details will never be provided to third parties for other
marketing purposes.
Page 4
Some courses may require the creation of technology user accounts. These accounts will be created from information obtained from this enrolment form. The personal
information for these accounts may be stored on international servers. As such your personal information may be held by international technology providers. Detailed
information can be found in Wyndham CEC's privacy policy. Tick this box to opt out of the creation of an electronic user account.
2015 v1
To get a job
To develop my existing business
To get a better job or promotion
If student under 18 years old:
Parent /guardian's name:
Parent /guardian's signature:
VETtrak student number
Mobile phone:
2015 v1
Page 1
Emergency contact name
Of the following categories, which BEST describes your current employment status? (Tick ONE box only)
Phone (mobile):
Phone (home):
What is the address location and postcode of the suburb, locality or town in which you usually live? 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.
Building/Property name:
Street Number (e.g. 5 or Lot 12)
Flat/Unit Number:
Street Name:
Suburb, locality or town:
Building/Property name:
Street Number
Street Name:
PO Box or roadside delivery box:
Suburb, locality or town:
E-mail address:
Are you of Aboriginal or Torres Strait Islander origin?
Yes, Aboriginal
In which country were you born?
(For persons of both Aboriginal and Torres Strait
Islander origin, mark both ‘Yes’ boxes)
Yes, Torres Strait Islander
Are you still attending secondary school?
What is your highest COMPLETED school level? Tick ONE box only.
Completed Year 12
Completed Year 10
Completed Year 11
Completed Year 9 or Equivalent
 6 - Sales Workers
 7 - Machinery Operators and Drivers
 8 - Labourers
 9 - Other
 Yes, other - please specify ___________________________
Very Well
Not Well
Not at all
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
 Learning
 Mental illness
 Acquired brain impairment
 Vision
 Medical condition: _______________________
 Other: _________________________________
Other Australian state
Overseas - please specify: ___________________________________
Have you SUCCESSFULLY completed any of the following qualifications? Yes
Do you speak a language other than English at home?
(If more than one language, indicate the one that is spoken most often).
Completed Year 8 or lower
Never attended school
 K - Financial and Insurance Services
 L - Rental, Hiring and Real Estate Services
 M - Professional, Scientific and Technical Services
 N - Administrative and Support Services
 O - Public Administration and Safety
 P - Education and Training
 Q - Health Care and Social Assistance
 R - Arts and Recreation Services
 S - Other Services
How well do you speak English?
In which YEAR did you complete that school level?
 1 - Managers
 2 - Professionals
 3 - Technicians and Trade Workers
 4 - Community and Personal Service Workers
 5 - Clerical and Administrative Workers
 No, English Only
Other - please specify
Are you an Australian citizen or permanent resident?
Where did you complete that school level?
Which of the following classifications BEST describes your current or recent occupation? (Tick ONE box only)
If unemployed go to next question.
 A - Agriculture, Forestry and Fishing
 B - Mining
 C - Manufacturing
 D - Electricity, Gas, Water and Waste Services
 E - Construction
 F - Wholesale Trade
 G - Retail Trade
 H - Accommodation and Food Services
 I - Transport, Postal and Warehousing
 J - Information Media and telecommunications
What is your postal address (if different from above)?
Flat/Unit Number:
 Employed - unpaid worker in a family business
 Unemployed - seeking full-time work
 Unemployed - seeking part-time work
 Not employed - not seeking employment
Which of the following classifications BEST describes the Industry of your current or previous Employer?
(Tick ONE box only)
If unemployed go to next question.
 Full-time employee
 Part-time employee
 Self-employed - not employing others
 Employer
Enter your Victorian Student Number (VSN)
No more questions if you provided your VSN.
If Yes, please enter one of these Prior Education Achievement Recognition Identifiers any applicable qualification level.
Have you attended any Victorian school since 2009 or done any training with a vocational education and training (VET) registered
training organisation or an Adult and Community Education provider in Victoria since 2011?
 Bachelor Degree or Higher Degree
 Advanced Diploma or Associate Degree
 Diploma (or Associate Diploma)
 Certificate IV (or Advanced Certificate/Technician)
 Certificate III (or Trade Certificate)
 Certificate II
 Certificate I
 Certificates other than the above
2015 v1
No - I have not attended a Victorian School since 2009 or a TAFE or other VET provider since the beginning of 2011.
No more questions if you answer No above.
A - Australian
E - Australian equivalent
I - International
 Yes - I have attended a Victorian school since 2009. Most recent Victorian school attended:
Note: If you have multiple Prior Education Achievement Recognition
Identifiers for any one qualification, use the following priority order to
determine which identifier to use:
1. A - Australian
2. E - Australian equivalent
3. I - International
Page 2
 Yes - I have participated in training at a TAFE or other training organization since the beginning of 2011. List the most recent
training organizations with which you have participated in training in Victoria since 2011 (List up to 3 training organizations)
2015 v1
Page 3