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Course Selection
Course
Training Plan
Training Location
Personal
Title
First Name
Middle Name
Last Name *
Date of Birth *
Gender *
Town/City of Birth *
Country of Birth *
USI
USI Number
Address
Address Lookup
Building/Property Name
Unit/Flat Number
Street Number *
Street Name *
Suburb *
State *
Postcode *
Country *
Postal Address
PO Box
Postal Building/Property Name
Postal Unit/Flat Number
Postal Street Number
Postal Street Name
Postal Suburb
Postal State
Postal Postcode
Postal Country
Contact
Email Address *
Mobile Phone
Education
What is your highest COMPLETED school level? *
Are you currently at school? *
What is your CURRENT school level?
Have you completed any other qualifications? *
Select all that apply *	Bachelor degree or higher degree level Advanced diploma or associate degree level Diploma level Certificate IV Certificate III Certificate II Certificate I Miscellaneous education
Which best describes your reason for this study? *
Demography
Which best describes your employment status? *
Are you an Aboriginal or Torres Strait Islander? *
Main language spoken at home *
Needs
Do you have a disability or impairment? *
Select all that apply *	Hearing/deaf Physical Intellectual Learning Mental illness Acquired brain impairment Vision Medical condition Other Not Specified
Do you have any individual needs?
Please Specify
Company Details
Company/Business Name
Company/Business Contact Name
Company/Business Email
Company/Business Phone
Company/Business Postal Address
Uploads
Identification	Please upload one form of identification (Drivers license, passport, or medicare card) (Note: maximum size is 8MB.)
Declarations
	I understand the terms of this Contract and the refund conditions and confirm that I have been fully advised of the fees, refund conditions and conditions of enrolment and agree to be a student at the RTO. I agree that it is my responsibility to retain a copy of this written agreement as supplied by the RTO and receipts of any payments of tuition fees or non-tuition fees. I agree that under the Data Provision Requirements 2012, the RTO is required to collect personal information about me and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER). My personal information (including the personal information contained on this enrolment form and my training activity data) may be used or disclosed by the RTO for statistical, regulatory and research purposes. The RTO may disclose my 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; Organisations 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, regulation, monitoring and evaluation.I may receive an NCVER student survey which may be administered by an NCVER employee, agent or third-party contractor. I may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose my 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).
	I have reviewed the student handbook, fee schedule, and course description available from this website and am informed about my rights and obligations, payment obligations and the services to be provided.
	I agree to the terms and conditions applicable to this enrolment and confirm that the information I have provided in this enrolment form is true and correct.
Payment Information
Initial Face-to-Face Training	$380.00
Payment Method	Secure online credit card payment Request an Invoice Payment not Required (either pre-paid or paid by employer/others - Company details above must be filled in)
Fee Free Funding Applicants	AgSkilled 3.0 Funding (to apply for funding you MUST complete an Application Form – the link will be available after you select SUBMIT below)
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RTO: 40867 | ABN: 76 162 043 825

RTO: 40867 ABN: 76 162 043 825

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