MPC Application

Please tick the appropriate boxes:*

CUA31020 - Certificate III in Screen and Media (Film & Design)CUA31020 - Certificate III in Screen and Media (Interactive)CUA40720 - Certificate IV in DesignCUA40720 - Certificate IV in Design (Video Production)CUA30920 - Certificate III in MusicCUA30920 - Certificate III in Music (Sound Production)CUA40920 - Certificate IV in MusicCUA40920 - Certificate IV in Music (Sound Production)

Unique Student Identifier (USI)*

What is a USI?

USI Authorisation*

Please tick this box to authorise MPC to verify your USI

Title*

Family Name*

Given Names*

Preferred First Name*

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Email*

Confirmation Email

Birth Date*

MonthDayYear

Phone (Home or Mobile)*

Where did you hear about Mount Pleasant College?*

Current School Name

Year Level

- OR - Highest Education Standard Attained

Emergency Contact Name*

Relationship to Applicant*

Emergency Contact Email Address*

Emergency Contact Phone Number 1*

Emergency Contact Phone Number 2

Contact for all invoicing / payment correspondence*

SchoolParent/GuardianStudent

Contact Name*

Contact Phone*

Contact Email*

I will be applying for Youth Allowance / Austudy / Abstudy*

Yes (only applicable for full time students)No

I will be submitting a separate application for Recognition of Prior Learning (RPL)*

YesNo

I am a returning student*

YesNo

Medical Info

Please list any significant illnesses, conditions or allergies

Please list any medications you are taking

Administering Medication

I can self-medicateI need assistance

Mount Pleasant College is required to hold written authorization from Parents/Guardians of students who are under 18 years of age before administering paracetamol. An email will be forwarded on each occasion, advising parents/guardians of the medication issued.

I/We authorize Mount Pleasant College to issue small amounts of paracetamol to my child.

Medical Emergency Procedure

Please list any other emergency contacts other than the one already listed earlier.

Emergency Contact Name

Contact Phone

Emergency Contact Name

Contact Phone

In the event of an emergency, I/we authorize MPC to secure an Ambulance and/or medical attention for my child.

Consent for Photographs*

I agree to give permission for any film or photographs taken within the college environment or activities; to be used for college publication. I acknowledge that this may include promotion for the college in print, screen and/or web format. (Please contact MPC Administration if this is an issue.)

Consent for Travel (parents/guardians to complete if student is under 18 years of age)

I give permission for student to travel accompanied/driven by their Supervisor/Instructor as part of course tasks.

Please indicate how student will travel to MPC

Please indicate how student will travel after classes

Meal breaks: Is student permitted to leave the College premises for meal breaks?

YesNo

Application Fee ($100) payable now*

Credit CardBank Transfer

*Please note that this fee is
separate from the tuition fees.

Secure Credit Card payment:*

MPC Application Fee$100.00AUD

Total $0.00AUD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Bank Transfer:
This transfer information will be emailed to you upon application submission. Transfer the application fee ($100) at your earliest convenience. MPC will follow up on the payment shortly.

Account: Mount Pleasant College
BSB: 066-163 (Commonwealth Bank)
Acc No.: 10367831
Amount: $100
Reference: Please identify with your surname + "MPCAPP"

Privacy Notice

Under the Data Provision Requirements 2012, Mount Pleasant College is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). Your personal information (including the personal information contained on this enrolment form and your training activity data) may be used or disclosed by Mount Pleasant College for statistical, regulatory and research purposes. Mount Pleasant College may disclose your personal information for these purposes to third parties including:

School – if you are a secondary student undertaking VET including a school based apprenticeship or traineeship;
Employer – if you are enrolled in training paid by your employer;
Commonwealth and State or Territory government departments and authorised agencies;
NCVER;
Organisation conducting student surveys; and
Researchers

Personal information disclosed to NCVER may be used or disclosed for the following purposes:

Issuing a VET Statement of Attainment or VET Qualification, and populating Authenticated VET transcripts;
Facilitating statistics and research relating to education, including surveys;
Understanding how the VET market operates, for policy, workforce planning and consumer information; and
Administering VET, including program administration, regularion, monitoring and evaluation

You may receive a NCVER student survey which may be administered by an NCVER employee, agent or third party contractor. You may opt out of the survey at the time of being contacted.

NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the VET Data Policy and all NCVER policies and protocols (including those published on NCVER's website at www.ncver.edu.au).

Student Declaration and Consent*

I declare that the information I have provided to the best of my knowledge is true and correct.

I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.

Student or Parent/Guardian* electronic acknowledgement (*if student is under the age of 18)*

Full Name

Date*

Date

Application Form