Enrolment Form

ENROLMENT FORM 2015
Please complete all sections on this form in pen.
(Office use only)
Rapid Enrol:
(date/initial)
Education ID:
(date/initial)
Student ID:
Other Details:
(date/initial)
USI created/validated:
(date/initial)
Which course/qualification are you enrolling in?
Library/ID Barcode Sticker
1. Enrolment Status
Have you enrolled with a Tasmanian TAFE/Polytechnic/Skills Institute before?
o Yes o No
2. Citizenship / Residency Status
Are you an Australian citizen?
o Yes o No
If NO, are you a New Zealand citizen?
If NO, are you a Permanent Humanitarian Visa holder?
Are you a permanent resident of Australia?
Are you a full fee paying International student?
o Yes
o Yes
o Yes
o Yes
o No
o No
o No
o No
(Non-permanent residents please contact GETI on (03) 6165 5727 or at [email protected]. Failure to properly declare your residency status will mean your enrolment
will be reviewed or cancelled)
3. Student Details
Surname:
Previous Surname (if applicable):
Given names:
Preferred name:
Date of Birth (Day/Month/Year): Town/City of Birth;
Title (Mr, Mrs, Ms, Miss, Dr, other):
Gender:
o Male o Female
Permanent Residential Address (must be completed)
Number and Street:
Town/Suburb:
State: Postcode:
Telephone (Home):
o Silent
Telephone (Mobile):
Telephone (Work):
Fax:
Email:
Postal Address (if different from above)
Number and Street/PO Box:
Town/Suburb:
State: Postcode:
Residential Postcode:
4. Emergency Contact
Contact Name:
Telephone (Home):
Telephone (Work):
Telephone (Mobile):
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ENROLMENT FORM 2015
5. Unique Student Identifier
The Australian Government requires all students to hold a Unique Student Identifier (USI).
Without a USI you cannot by law receive formal recognition of your studies.
If you know your USI please provide it here:
If you do not know your USI, or do not hold one,TasTAFE will apply for a USI on your behalf. To do this you must supply one
identity document from Category A. Once created the Australian Government will provide you with your USI by mail.
6. Evidence of Identity Must be at least 50 points
If USI not supplied above you must provide at least one identity document from Category A.
If unable to reach the 50 points requirement from Category A you may select from Category B.
If USI is supplied above then you can select 50 points from either Category A or Category B documents.
Category A (Please provide Document Reference Details as specified below)
ID
Australian Birth Certificate
Document Reference Details
Points
Registration State:
Registration number:
(include any letters)
Date of Registration:
Date of issue of certificate:
70
Certificate number (If issued in ACT, NSW, NT or SA after 1 July 1999):
Driver’s Licence
Licence number:
State of issue:
40
Medicare Card
Name as it appears on card:
Card number:
Individual reference number:
20
Expiry date:
Card colour:
Australian Citizenship Certificate
Stock number:
Acquisition date:
Australian Passport
Document number:
Australian Visa (with Non-Australian Passport)
Passport number:
Certificate of Registration by Descent
Acquisition date:
70
ImmiCard
Card number:
70
70
70
Passport Country of issue:
70
Category B
This list below is not exclusive. Refer to the ‘Proving your identity’ reference document for acceptable documentation and their value.
ID
Document Details
Points
Financial Institution Card
o Current ATM or credit card showing your name and signature
40
Centrelink Concession Card
o Current card issued in your name with your signature
40
Educational Certificate
o Up to three school/educational qualification certificates for different years in your
name or former name (school, TAFE, university, Registered Training Organisation (RTO))
40
Personal Identification Card
o Current Personal Information Card issued by Service Tasmania.
40
Firearms Licence
o Current firearm licence showing signature and/or photo and same name as claim
40
Australian Marriage Certificate
o Marriage certificate issued by a State/Territory government agency (i.e. BDM Registry).
Cannot accept: church or celebrant-issued certificates
40
Australian Divorce Papers
o Australian divorce papers in your name (or former name)
(Divorce paper issued by an Australian Court)
40
Name Change
o Legal change of name certificate or deed poll certificate
40
Student ID Card
o Current student identity card issued in your name with signature and/or photo
(school, TAFE, university, RTO)
20
Health Insurance Card
o Current health insurance card showing your name
10
Electoral Enrolment
o Proof of electoral enrolment card issued in your name and same address as claim
10
(TasTAFE Staff use only)
ID sighted by: ________________________________________________________________________________ Date: _____ / ______ / ______
Original documents can be sighted at, or send certified copies to Client Services Centres. For more information call 1300 655 307.
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ENROLMENT FORM 2015
7. Disability or Medical Information
Do you have a disability or medical condition which may impact on your studies? Please indicate the area(s) of impairment:
o Acquired Brain Injury
o Hearing
o Mental Health
o Physical
o Yes o No
o Intellectual
o Vision
o Learning
o Neurological
o Other (please specify)
o Medical Condition (please specify)
Do you wish to be contacted about available support services for your disability or mobility or access issue?
Do you have a medical condition which may require First Aid of which your teacher should be made aware?
o Yes o No
o Yes o No
If Yes, please complete a Medical Advice/Alert form
8. Indigenous Status (Tick applicable boxes)
Are you of Australian Aboriginal and/or Torres Strait Islander origin?
o Yes, Australian Aboriginal
o Yes, Torres Strait Islander
o No
9. Cultural Diversity
What is your country of birth? (if not in Australia)
Year of arrival in Australia?
Do you speak a language other than English at home?
o No, English only
o Yes, please indicate the language which is spoken most often?
If Yes, how well do you speak English?
o Very well
o Well
o Not well
o Not at all
10. Prior Achievements (Tick applicable boxes)
Have you successfully completed any of the following qualifications?
o Bachelor or Higher Degree
o Certificate IV
o Advanced Diploma or Associate Level
o Certificate III
o Diploma Level
o Certificate II
o Certificate I
o Certificates other than above (e.g. TCE)
11. Marketing Source (Tick one box only)
How did you find out about the course?
o Student Counsellor
o Industry Publications
o Employer
o Word of Mouth o Expos and Events
o Online Advertising o Flyers/Posters/Printed Materials
o Newspaper Advertising
o Newspaper Articles o School Pathway Planning Officer
o Radio o Television
o Re-enrolment o TasTAFE Website
o Social Media (Facebook/Twitter)
o Other
12. Employment Status (Tick one box only)
Which best describes your current employment status?
o Full-time employee
o Employer
o Unemployed – seeking part-time work
o Part-time employee o Employed – unpaid work in a family business
o Not employed – not seeking work
o Self-employed – not employing others o Unemployed – seeking full-time work
13. Schooling
Are you still attending School/College?
o Yes o No
If YES, which School/College?
If YES, what is your current year level?
If NO, what is your highest completed school level?
o Did not go to school
o Year 9 or equivalent o Year 8 o Year 10 o Year 11 or lower
o Year 12
In which year did you complete that school level?
Tasmanian school attended?
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ENROLMENT FORM 2015
14. Reason for Study (Tick one box only)
o To get a job
o To develop my existing business o To start my own business o Other reason
o To try for a different career
o To get a better job or promotion
o It is a requirement of my job o I wanted extra skills for my job
o To get into another course
o For personal interest or self-development
15. Employer Contact Details
(Apprentices, Trainees and School-Based Trainees Only)
Business name:
Contact name:
Number & Street:
Town/Suburb:
State:
Postcode:
Telephone (W):
Mobile:
Fax:
Email:
16. Concession (Available for Certificate I to IV only)
I am applying for a fee Concession
o Yes (If Yes, attach proof of eligibility eg. copy of Centrelink card)
o No
o Yes (If Yes, you will need to attach a Sponsor Authorisation form)
o No
17. Third Party Payment
Are your fees being paid for by a Sponsor (e.g. employer)
18. Credit Card Details (Do NOT complete if paying in person)
Card Type:
o Mastercard
o Visa
Card Number:
Card Holder:
Expiry Date:
(Office use only)
Signature:
Payment processed (date/initial): _______________________
Declaration
Under the Personal Information Protection Act 2004 TasTAFE is the custodian of personal information and subject to the requirements of that Act in regard
to the collection, use and disclosure of personal information.
I understand that TasTAFE, by law, must hold a Unique Student Identifier for each student undertaking nationally accredited training. I consent
to TasTAFE creating a Unique Student Identifier on my behalf if required and that I agree to the USI Privacy Statement available to me at
www.tastafe.tas.edu.au/usi or at the Client Services Centre on each campus.
I understand that information contained in these forms may be provided to the Department of Education, State and Commonwealth agencies and to
research organisations.
If and for so long as my education and training is paid for by a parent, guardian or sponsor, or I am under a training contract with an employer, I consent
to the release by TasTAFE of information relevant to my progress and results to such parent, guardian, sponsor or employer.
I agree to adhere to the relevant Student Code of Conduct and By-Laws and to the Computer Network User Guidelines as in force from time to time.
I certify that all details provided on this form by me are true and correct.
Student Signature Please note: Confirmation of course enrolments will be subject to viable numbers.
STUDENT, PLEASE CHECK THAT YOU HAVE:
o Completed all details
o Read and signed the Declaration
o Attached a completed Tick Sheet signed by you and your teacher.
o A Training Subsidy Information form should also be attached where applicable.
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Date: _____ / ______ / ______