Wickramasinghe Institute of Training Pty. Ltd

Wickramasinghe Institute of Training Pty. Ltd
102/26, D.S. Office Road, Pangolle Junction, Ibbagamuwa.
Tel: 037 2259964 Mobile: 071 8009767
Email: [email protected] or [email protected]
STUDENT ENROLMENT FORM
COURSE/QUALIFICATION APPLIED FOR:
Office use only:
Start Date:
Delivery Mode:
Time:
Classroom Correspondence Fee:
Online Student Details
Surname
Other names
Gender: Male Female
DOB
/
Mr / Mrs/ Ms / Miss
/
Birth place
Home Address:
Postcode:
Postal Address:
Postcode:
Telephone:
Mobile:
Email:
Have you ever completed a training course with DRs TQM Pty. Ltd before?
Yes No
WORK DETAILS
Company / Business Name :
Home Address:
Postal Address:
Telephone:
Postcode:
Postcode:
Mobile:
Email:
HOW DID YOU HEAR ABOUT THIS COURSE?
Email Website Word of mouth Other Please state:_________________
NEXT OF KIN DETAILS
Name :
Relationship :
Contact Number:
Home:
Mobile:
EDUCATION BACKGROUND DETAILS
Are you still attending
Yes No
school?
If No
Year 8
What is your highest
Year 12
completed school level?
In What calendar year did you complete school?
What Year are you in? _________
Year 11
Year 10
Year 9
Year _________
PREVIOUS TRAINING DETAILS
Have you successfully completed
any of the these qualifications?
Qualification details
Certificate I
Certificate IV
Bachelor/ Masters Certificate II
Diploma
Certificate III
Advanced Diploma
Other Certificate ………………………
…………………………………………………………………………………………………………………..
Year completed ?
Title of qualification?
Copyright © 2010 DR’s Total Quality Management Training Service Pty Ltd
[This document will no longer be version controlled once printed]
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Wickramasinghe Institute of Training Pty. Ltd
102/26, D.S. Office Road, Pangolle Junction, Ibbagamuwa.
Tel: 037 2259964 Mobile: 071 8009767
Email: [email protected] or [email protected]
STUDENT ENROLMENT FORM
LANGUAGE
What language do you speak at home?
How well do you speak English?
English
Very Well
Well
Other ……………………………
Not well Minimal
STUDY REASON
Which of the following statements
best describes your reason for
completing the course?
Personal interest
To get a job
Job requirements
To gain a qualification
For promotion
Other
……………………………………………………
SPECIAL NEED / DISABILITY
Do you have any condition that could hinder your learning capacity? Yes (please specify below)
Acquired Brain injury
Intellectual
Medical condition
Physical condition
Hearing /Deaf
Learning difficulty
No Mental illness
Vision impairment
Other, please specify :
PAYMENT DETAILS
Employer to pay course fee amount of $ ……………………………….
Please find enclosed a cheque  (payable to DRs TQM Pty. Ltd  for the course fee amount of $ ………………………
CERTIFICATE ISSUING POLICY:
•
•
Participants must complete all study requirements (face to face hours, assignments, project works, work placement hours and
pay full amount of the course to receive the certificate.
REFUND POLICY:
Participants who withdraw from a course prior to the commencement of the course may be entitled to a part refund. Refunds
are provided on a sliding scale determined by the amount of notice you provide. For a full copy of the Refund Policy, visit our
website or contact us.
This course may be cancelled if insufficient bookings are received 7 days prior to the commencement date. If for any reason
the course is cancelled by DRs TQM Pty. Ltd, a full refund of fees will be made, however we do not accept any liability for
airfares or pre-paid accommodation expenses.
IMPORTANT INFORMATION:
All enrolments are confirmed in writing before the course starts, giving details of the course start times and venue. In the
unlikely event you do not receive confirmation of a course prior to the commencement date, please contact us immediately.
PRIVACY STATEMENT
The Primary purpose of collecting personal information that you supply on this form is to process your registration. We may
also use these details to keep you informed of upcoming events and will not disclose your information to a third party. For
more details of DRs TQM Pty. Ltd ’s Privacy Policy, please visit the website at www.witlk.com or contact CEO –WIT Ltd. Pty.
Student Policy declaration
I have read and understand the rules and regulations and/or conditions of the Wickramasinghe Institute of Training and
do agree to follow them and abide by them during the course period. I also understand that failure to pay the course fee in
prescribed date and /or breach of rules and regulations and/or conditions will be eventually disqualified me from attending
the course/courses conducted by this institute without any right to reclaim any payment of advance or any fee to the
institute paid until such time of disqualification.
Signature:……………………………………………………………………… Date:…………… /…………… /……………………
Please attach:
1. Certified copies of Educational Certificates
2. Certified copy of Police Clearance Certificate.
Copyright © 2010 DR’s Total Quality Management Training Service Pty Ltd
[This document will no longer be version controlled once printed]
C:\Users\Chandana\Desktop\Enrolment Form_english.doc
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