ENROLMENT FORM 2007 STATISTICAL DATA

							ENROLMENT FORM 2007 v1
STATISTICAL DATA

ENROLMENT FORM 2007                     v1 - PERSONAL DETAILS

Family Name:__________________             Given Names:____________________               Pref Name: _________________

Sex       M          F       Date of Birth: __/__/_         Tel Hm:________________       Tel Wk: ____________________

Tel Mob: ______________________            Email: _________________________________________________________

Mailing Address: ______________________________________________                       Suburb:_________________________

                                                                                      Postcode:_______________________


Pre Training Review                                                                                             Please tick
       Do you already hold the qualification / competency to which you are enrolling?                 Yes            No
       Can you read and write English well?                                                           Yes            No
       Can you hold a conversation in English?                                                        Yes            No
       Do you have reasonable numeracy skills?                                                        Yes            No
       Do you require literacy or other learning assistance?                                          Yes            No
       Do you have a disability or special circumstance that requires assistance?                     Yes            No
       This program is flexi-mode (increased home study/less class time).                             Yes            No
       Does this program suit your needs?
       Does this course / competency suit your desired employment outcome?                            Yes            No
       Have you read the training plan?                                                               Yes            No

Criminal Check – Security Course Only

       Have you been convicted of drug trafficking in the past 10 years?                              Yes            No
       Have you been convicted of assault in the past 10 years?                                       Yes            No
       Have you been convicted of any offence (not traffic) which may make you
       unfit to hold a crowd control or security guard licence?                                       Yes            No



Signed: _____________________________________________________________ Date: ____/____/____

Course: __________________________                Day Course                 Evening Course           Weekend Course
Dates: ___________________________                Times: __________          Location: _________________________
      Cheque          Money Order         Cash        Credit Card:           Bankcard            Mastercard          Visa
Cardholders Name: ________________________                     Expiry Date: ___/___/__        Amount: $______________
No.___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ ___ Signature:
______________________

Payment will be processed by “IAscend Tafe P/L” by signing you agree to this charge
Office Use Only                                                                                             Status

Student No: ______________               Video Kit Nos.: Sec _____________              First Aid: _______________


Payment Details:

                   Date                                      Amount                                    Method
ENROLMENT FORM 2007 v1
STATISTICAL DATA


    1.   ETHINICITY                                                     10. DISABILITY
         Are you of Aboriginal or Torres Strait Islander Origin?
                                                                            Do you consider yourself to have a permanent and
         (tick one box)             Yes         No
                                                                            significant disability?
    2.   BIRTHPLACE
                                                                            (Tick one box)                        Yes      No
         Were you born in Australia?                 Yes           No
         If NO, Which country were you born in?
                                                                            If YES, then of the following categories, which BEST
         _______________________________________________                    describes your current disability?

    3.   ARE YOU STILL ATTENDING SECONDARY SCHOOL?
                                                                                 Hearing
         Yes      No
                                                                                 Physical
                                                                                 Mental Illness
    4.   HIGHEST SCHOOL ACHIEVEMENTS SO FAR
                                                                                 Intellectual
         What is your highest COMPLETED school level?
                                                                                 Acquired Brain Impairment

               Completed Year 12                                                 Visual/Sight/Seeing

               Completed Year 11                                                 Medical Condition
               Competed Year 9 or Equivalent                                     Other
               Completed Year 8 or Lower
               Did not go to school                                     11. Have you SUCCESSFULLY completed any of the
                                                                            following qualifications?        Yes      No

    5.   WHAT YEAR WERE YOU LAST AT SCHOOL? __________                      If YES, then tick ANY applicable boxes.

                                                                                 Bachelor Degree or Higher Degree
    6.   WHERE ABOUTS WAS YOUR LAST SCHOOL? __________
                                                                                 Advanced Diploma or Associate Degree
    7.   Of the following categories, which BEST describes
         your current employment status? (Tick ONE box only)                     Diploma (or Associate Diploma)
               Full-time employee
                                                                                 Certificate IV (or Advanced Certificate/Technician)
               Part-time employee
                                                                                 Certificate III (or Trade Certificate)
               Self employed- not employing others
                                                                                 Certificate II
               Employer
                                                                                 Certificate I
               Employed- unpaid family worker
                                                                                 Certificates other than the above
               Unemployed- seeking full-time work

               Unemployed- seeking part-time work                       12. EMPLOYMENT

               Not employed- not seeking employment                         Of the following categories, which BEST describes

                                                                            your reason for undertaking this course?

    8.   LANGUAGE                                                                To get a job
         Do you speak a language OTHER THAN ENGLISH at home?                     To develop my existing business
                                                                                 To start my own business
         (Tick one box)     Yes           No
                                                                                 To try for a different career
                                                                                 To get a better job or promotion
         If YES, which language       _____________________________              It was a requirement of my job
                                                                                 I wanted extra skills for my job
                                                                                 To get into another course of study
    9.   HOW WELL DO YOU SPEAK ENGLISH?                                          For personal interest
               Very well                                                         For self development
               Well                                                              Other reasons
               Not Well
                                                                        WHAT IS THE POST CODE WHERE YOU USUALLY LIVE?
               Not at all
                                                                                 ___________
                                                            IMPORTANT!!
                             Please check that you have answered all questions and completed all personal
                                                               details