STUDENT ENROLMENT FORM

Transcription

1 STUDENT ENROLMENT FORM All prospective students are to complete this enrolment form. Please print in black or blue pen. This form must be submitted in person to Monash Short Courses along with any supporting documents required. NOTE: No enrolment will be processed unless this form is fully completed and the declaration is signed to indicate your understanding and agreement with all conditions. Section 1: Course Information COURSE CODE AND NAME COURSE STREAM/TIMETABLE TICK IF YOU WISH TO APPLY FOR: RPL OR CREDIT TRANSFER Please see the Student Information Handbook for details. Section 2: Student details Surname: Date of birth: Unique Student Identifier (USI) Given names: Sex: Male Female What is the address and postcode where you usually live? (Street Number and Name not Post Office box) Building/Property Name: Flat/Unit Number: Street Number: Suburb: Phone: Street Name: Postcode: Mobile: Postal Address: What is your postal address (if different from above)? Building/Property Name: Flat/Unit Number: Street Number: Suburb: Section 3: AVETMISS information In which country were you born? Australia Other City/Town of Birth Street Name: Postcode: Are you an Australian citizen or permanent resident? Yes No If No specify nationality: Of the following categories, which BEST describes your current employment status? (Tick ONE box only) Version 4.3 November 2015 Page 1

2 Full-time employee Part-time employee Self-employed not employing others Employer Employed unpaid worker in a family business Unemployed seeking full-time work unemployed seeking part-time work not employed not seeking employment Which of the following classifications BEST describes your current or recent occupation? (Tick ONE box only) If never employed go to school details. Manager Professionals Technicians and Trade Workers Community and Personal Service Workers Labourers Which of the following classifications BEST describes the industry of your current or previous Employer (Tick ONE box only) If never employed go to School details. Agriculture, Forestry and Fishing Mining Manufacturing Electricity, Gas, Water and Waste Services Construction Public Administration and Safety Wholesale Trade Retail Trade Services Accommodation and Feed Transport, Postal and Warehousing Information Media and Telecommunications School details: Are you still attending secondary school? Yes No In which YEAR did you complete that school level? Clerical and Administrative Workers Sales Workers Machinery Operators and Drivers Other Financial and Insurance Services Rental, Hiring and real Estate Services Professional, Scientific and Technical Services Administrative and Support Services Education and Training Healthcare and Social Assistance Arts and Recreation Services Other Services What is your highest COMPLETED school level? Year 12 Year 11 Year 10 Year 9 or equivalent Year 8 or lower Never attended school Name of most recent secondary school attended: Victorian Student Number to be completed by students aged 24 yrs and below Enter your Victorian Student Number: Have you attended any Victorian school since 2009 or done any training with a vocational education and training (VET) registered training organisation or an Adult and Community Education provider in Victoria since 2011? No I have not attended a Victorian school since 2009 or a TAFE or other VET training provider since the beginning of Yes I have attended a Victorian school since 2009: Most recent Victorian school attended: And/or Yes I have participated in training at a TAFE or other training organisation since the beginning of List the most recent training organisations with which you have participated in training in Victoria since 2011: Version 4.3 November 2015 Page 2

3 Other details: Are you of Aboriginal or Torres Strait Islander origin? For persons of both Aboriginal and Torres Strait Islander origin, mark both Yes boxes. No Yes, Aboriginal Yes, Torres Strait Islander How well do you speak English? Very well Well Not well Not at all Do you speak a language other than English at home? Yes No If Yes please specify. If more than one language, indicate the one that is spoken most often: Disability: Do you consider yourself to have a disability, impairment or long-term condition? Yes No If answered yes, then please indicate below. You may indicate more than one: Hearing/deaf Physical Intellectual Learning Mental Illness Acquired brain Vision Medical condition Impairment Other, please specifiy: Prior education: Have you SUCCESSFULLY completed any of the following qualifications? Yes No If Yes please enter ONE of these Prior Education Achievement Recognition Identifiers ANY applicable qualification level. A Australian E - Australian Equivalent I International A E I Bachelor Degree or Higher Degree Advanced Diploma or Associate Degree Diploma (or Associate Diploma) Certificate IV (or Advanced Certificate/Technician) Certificate III or Trade Certificate Certificate II Certificate I Certificates other than those listed Please provide details of these courses (if applicable): Eg. BSB30412 Certificate III in Business Administration, Monash Short Courses Centre, Section 4: Course Details Of the following categories, which BEST describes your main reason for undertaking this course? (tick ONE box only) To get a job To start my own business To get a better job or promotion I wanted extra skills for my job For personal interest or self-development To develop my existing business To try for a different career It was a requirement of my job To get into another course of study Other reasons Version 4.3 November 2015 Page 3

4 Fees Please refer to the 2016 Indicative Student Tuition Fees list which can be obtained from our website or by contacting our office. Are you applying for government funding? YES NO If Yes please complete the Victorian Guarantee 2016 Evidence of Eligibility and Student Declaration form. If you are eligible for a concession rate please complete your details below: Type of concession card: Card Number: Expiry Date: If you are applying for a concession we will need to take a photocopy of the original card when you enrol. Where did you hear about us? Community Centre Facebook Website Brochure on Campus Mailout Monash Faculty Open Day Employer/Agency Section 5: Declarations Privacy Statement Please read the information below and sign if you agree to how your personal information may be used: I understand that: Monash Student Association is required to provide the Victorian Government, through the Department of Education and Training, with student and training activity data which may include information I provide in this enrolment form. Information is required to be provided in accordance with the Victorian VET Student Statistical Collection Guidelines (which are available at htpp:// The Department may use the information provided to it for planning, administration, policy development, program evaluation, resource allocation, reporting and/or research activities. For these and other lawful purposes, the Department may also disclose information to its consultants, advisers, other government agencies, professional bodies and/or other organisations. I have been advised by the training organisation that I may be contacted and requested to participate in a National Centre for Vocational Education Research survey or a Department-endorsed project or audit or review. The Education and Training Reform Act 2006 requires Monash Student Association to collect and disclose my personal information for a number of purposes including the allocation to me of a Victorian Student Number and updating my personal information on the Victorian Student Register. For more information in relation to how student information may be used or disclosed please contact Monash Student Association s Privacy Officer on or shortcourses@monash.edu. If you do not already have a Unique Student Identifier (USI) and you want Monash Short Courses to apply for a USI to the Student Identifiers Registrar (Registrar) on your behalf, Monash short courses will provide to the Registrar the following items of personal information about you: Your name, including first or given name(s), middle name(s) and surname or family name as they appear in an identification document; Your date of birth, as it appears, if shown, in the chosen document of identity; Your city or town of birth; Your country of birth; Your gender; and Your contact details. I acknowledge and agree to the terms described in this privacy statement. Local Library School Career Advisor my.monash portal Newspaper Signature: Print Name: Date: Version 4.3 November 2015 Page 4

5 Conditions In completing this enrolment form the student is agreeing to a contract with Monash Short Courses that stipulates the following: Once the student commences the nominated course, Monash Short Courses will deliver the Training Program using competency based training principles and practices in accordance with the AQTF (Australian Quality Training Framework) Monash Short Courses and the student agree to work together to produce a unified approach in the student achieving the relevant qualification. Consenting to Monash Short Courses to pass on the above information to the Student Identifiers Registrar so we can apply for a unique student identifier on the student s behalf. The course fees payable to Monash Short Courses are for the provision of the following services: Training and Assessment Ongoing Administration Processes Certification/Statement of Attainment Where a student has undertaken an assessment and it has been marked as Not yet Competent (NYC), they be allowed to re-sit the test/or have a re-assessment. If they are deemed NYC for a second time they are to reenrol into that unit/ subject. This will include re-training and therefore a re-enrolment fee for the unit will apply. For re- issuance of Certificates and Statements of Attainments the student will be charged $22 per document required. Payment for the re-issuance of such documents is required prior to the re-issuance occurring. Monash Short Courses reserves the right to accept or reject any application for enrolment at its discretion. Monash Short Courses reserves the right to cancel any course prior to the commencement date of the course should it deem it necessary and in that event, shall refund all payments received from the student (see refund policy). Student Declaration In signing and submitting this Enrolment Form and this declaration section the student acknowledges: That the information provided by the student in this enrolment form is complete and correct. That providing any false information and / or failing to disclose any information relevant to my application for enrolment and / or failure to complete an application / enrolment form may result in the withdrawal of any offer, particularly as it relates to my eligibility to obtain an offer for government subsidised training, and / or cancellation of enrolment at the discretion of Monash Short Courses. Agrees to be bound by the Monash Short Courses rules and regulations and any amendments made to the rules and regulations. Agrees to undertake Language, Literacy and Numeracy testing requirement prior to acceptance into any course entry and adhere to any other pre-requisites identified through the enrolment process. Where a student s contact details change while studying with Monash Short Courses the student must advise Monash Short Courses of these changes within 7 days. These details include but are not limited to details such as , address, and contact phone details. If my enrolment is funded by HESG, then I confirm that the information I have given in relation to my eligibility is true and correct and I will show Monash Short Courses original certificates or other evidence as required and that they may take copies of these and release them to HESG as a part of their audit process. The Student Information Handbook has been read and understood. Agrees to the Enrolment Conditions (listed above in this document) Payment is attached for enrolment into this course as outlined in this enrolment form/ has been made for the course Student Name (Please Print): Student Signature: Date: Version 4.3 November 2015 Page 5

6 OFFICE USE ONLY Statement of Fees Monash Short Courses (TOID 21526), ph Student Name: Course duration (nominal hours): Course Code: Course Title: Mode of delivery: Classroom Online Blended Location: Clayton Caulfield Berwick Peninsula Workplace Work placement required? Yes, number of hours: No Third party providers: Healthguard First Aid (ph ) Not applicable Eligible for Government Funding? Yes, Government contribution: $ No Eligible for Concession? YES NO Total Fees Payable: $ OFFICE USE ONLY Payments Payment method: Cash Cheque Card Invoice Credit Card Details: Visa MasterCard Card Number: Expiry Date: / Cardholder Name: Signature: Deposit Payment Amount Paid: $ Date: Staff signature: Payment Plan Details: Due Date Instalment Amount Payment Received Student Authorisation I authorise Monash Short Courses to charge my credit card for my payment plan instalments as outlined in the payment plan above. I agree to ensure that sufficient credit is available on my card for each of the payments to be processed and I understand that a default on any one or more payments may result in my enrolment being suspended. Student signature: Date: Staff signature: Date: Version 4.3 November 2015 Page 6