Enrolment Form

Enrolment Form

Confidential
Course Selection
Mode of Study*

Monthly WorkshopsSelf-Paced with video tutorial supportSchools ProgramRemote (Rural online delivery)
Would you like to be contacted about a Double Qualification Pathway?

YesNo
Personal Details
Full Name*

PrefixFirst NameMiddle NameLast Name
Have you been known by any previous names?*

NoOther
Company/Employer/School
Gender*

MaleFemale
Date of Birth*

DayMonthYear
USI Number (if known)
Do you give permission for Learning Partnerships to find or create a USI number on your behalf?*

YesNo
E-mail*
Phone Number*

Area CodePhone Number
Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Postal Address (if different to above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone Number

Phone Number
Language and Cultural Identity
Do you identify as Aboriginal and/or Torres Strait Islander*
What Country were you born?*

AustraliaOther
In which city/town were you born?*
Do you speak a language other than English at home?*

NoOther
Previous Academic History
What is your highest completed school year level?*

12111098 or lowerDid not attend high school
In what year did you finish school?*
What city/town did you complete?*
Have you successfully completed any of the following qualifications?*

NoBachelor degree or higher degreeAdvanced Diploma of Associate DegreeDiploma (or associate Diploma)Certificate IV (or Advanced Certificate/Technician)Certificate III (or Trade Certificate)Certificate IICertificate I
Are you wishing to apply for Credit or Recognition of Prior Learning (RPL)?

Yes, Credit TransfersYes, RPL PartialYes, both Credit and RPLNo
Employment History
Which category best describes your current employment status?*

Full time employeePart time employeeEmployerSel employed - not employing othersEmployed - unpaid worker in family businessNot employed - not seeing employmentUnemployed - seeking full time workUnemployed - seeking part time work
Do you have a disability, impairment or long term condition?*

YesNo
Please choose as many as applicable

Acquired Brain ImpairmentMental IllnessLearning/Language/Literacy or NumeracyIntellectualPhysicalVisionMedical ConditionHearing/deafOther
Do you believe you require support with completing your studies?

YesNo
Which BEST describes your reason for enrolling in this course

To get a jobTo develop my existing businessTo start my own businessTo try for a different careerTo get a better job or promotionIt was a requirement of my jobI wanted extra skills for my jobTo get into another course of studyFor personal interest or self developmentOther
Please upload a form of Photo ID

Upload a File
Eg. Drivers License - A photo is fine. If applying for a Concession Discount proof of concession is required Cancelof
Please upload qualifications and/or Resume for Credits or RPL

Upload a File

Cancelof
Payment Option

Upfront PaymentPayment Plan
Would you like to see if you are eligible for Certificate 3 Guarantee Funding or Higher Skills Level Subsidy?

YesNo
Discount code or offer
Please leave blank if you do not have one
Declaration

- I declare that everything I have stated is true and correct at the time of enrolment.

- I agree to abide by the terms and conditions outlined in the Learner Handbook

- I understand that my personal information will be disclosed to Australian Commonwealth and State Government agencies for the purpose of data planning, administration, policy development, program evaluation, resource allocation, reporting, research activities, verifying funding eligibility or if required to release to a Law enforcement Agency and that Learning Partnerships as a Registered Training Organisation (31719) and Australian Government Agencies are bound by privacy legislation committed to storing personal information confidentially and securely

- I understand that I may receive information about current and future programs from Learning Partnerships and may opt out of this by unsubscribing
Full Name

First NameLast Name
Signature
Date

DayMonthYear
Should be Empty:

Enrolment Form

Personal Details

Language and Cultural Identity

Previous Academic History

Employment History