Please fill in all sections carefully. Information requested on this form is for national database and tracking purposes and assists in ongoing qualification issuance as required. All data is confidential and is not forwarded to any other party with the sole exception of the national statistical database to inform future federal funding in Vocational Training.


PERSONAL DETAILS *
PERSONAL DETAILS
Date of Birth *
Date of Birth
Gender *
Residential Address *
Residential Address
Postal Address
Postal Address
if same as above please leave blank
Name of Course/Qualification enrolling in
Date of Enrolment
Date of Enrolment
Applicable to Traineeships only
EMPLOYMENT *
Of the following categories, which best describes your current employment status? (Tick ONE box only)
Employer Business Name
Employer Address
Employer Address
LANGUAGE & CULTURAL DIVERSITY *
Are you of Aboriginal or Torres Strait Islander origin? (for both Aboriginal AND Torres Strait Islander origin, mark both 'Yes' boxes)
Do you speak a language other than English at home? *
How well do you speak English? *
EDUCATION *
What is your highest completed school level?
Are you still attending secondary school? *
Have you successfully completed any of the following qualifications?
DISABILITY *
Do you consider that you have a disability, impairment or long-term condition? (you may indicate more than one area)
STUDY REASON *
Of the following categories, which best describes your main reason for undertaking this course/traineeship/apprenticeship? (Tick ONE box only)
UNIQUE STUDENT IDENTIFIER (USI) *

By submitting this form you are agreeing that you understand the information contained may be provided to State and Commonwealth agencies and research organisations and consent to that occurring. You also certify that all details provided on the form is correct.