ENROLMENT APPLICATION FORM CHC30113 Certificate III in Early Childhood Education and Care About this application Use this Enrolment Application to apply for enrolment in the CHC30113 Certificate III in Early Childhood Education and Care. Before completing this Enrolment Application, please make sure you read and understand the program structure and requirements as outlined on our website at goodstart.edu.au. Do not complete this application if you wish to apply for Recognition of Prior Learning (RPL). To apply for RPL, please refer to the RPL application page at goodstart.edu.au. Filling out and submitting this form Please complete all sections within this form as indicated. Make sure all information you supply is legible, accurate, and correct. This is an editable PDF document. If you choose, you can type your answers into the PDF, using your mouse or pressing the Tab key to move between fields. Print your completed application, sign where applicable, and send the document along with any additional forms as required (eg, Employer Funded Study Assistance) by either post or email. If sending via email, send a scanned version of the form. Post Attn: Enrolment Applications PO Box 12089 George Street Brisbane Qld 4003 Email goodstart@goodstart.edu.au Subject line: Enrolment Applications 1 About You Please enter the following details as shown on either your Australian Driver s Licence, Passport, or Australian 18+/Over 18 Card. All fields are mandatory. Title Family name Given name Middle name Gender Male Female Date of birth I have attached one of the following forms of identification to confirm these details (please specify) Australian Driver s Licence Passport Australian 18+/Over 18 Card Please attach a copy of your chosen form of photo identification to confirm these details 1/8
2 Unique Student Identifier (USI) As of 1 January 2015 all new and continuing students need to apply for a Unique Student Identifier (USI). A USI gives you access to a government online portal that will contain all of your nationally recognised training records and results from 1 January 2015 onwards. If you already have a Unique Student Identifier (USI), please enter your USI in the field below: Unique Student Identifier If you do not have a USI, you ll need to apply for a USI before we can complete your enrolment. You may apply directly via the USI website (www.usi.gov.au). Alternatively, can apply for a USI on your behalf. If you would like the Institute to apply for your USI, please complete the following USI application below. You ll need to supply a valid form of identification in order to process your USI application. USI application Before completing this section, please ensure you have attached a copy of one of the following forms of valid identification documents. Please tick the document you have attached below: Australian Driver s Licence Australian Medicare Card Australian Passport Valid and current Visa (with non-australian Passport) Certificate of Australian Registration by Descent Australian Birth Certificate (full certificate extracts are not accepted) ImmiCard (issued from the Department of Immigration and Citizenship) Australian Citizenship Certificate Please enter your details as they appear on your identification document: First name Middle name Family name Gender Male Female Date of birth Town or city of birth Country of birth I have read the USI Privacy Statement located on page 3 of this application and give my permission for Goodstart Institute to apply for an Unique Student Identifier (USI) on my behalf. Student signature Date 2/8
Privacy Statement Unique Student Identifier If you do not already have a Unique Student Identifier (USI) and you want to apply for a USI to the Student Identifiers Registrar (Registrar) on your behalf, 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. When we apply for a USI on your behalf the Registrar will verify your identity. The Registrar will do so through the Document Verification Service (DVS) managed by the Attorney-General s Department which is built into the USI online application process if you have documents such as a Medicare card, birth certificate, driver licence, Australian passport, citizenship document, certificate of registration by descent, ImmiCard or Australian entry visa. If you do not have a document suitable for the DVS and we are authorised to do so by the Registrar we may be able to verify your identity by other means. If you do not have any of the identity documents mentioned above, and we are not authorised by the Registrar to verify your identity by other means, we cannot apply for a USI on your behalf and you should contact the Student Identifiers Registrar. In accordance with section 11 of the Student Identifiers Act 2014 Cth (SI Act), we will securely destroy personal information which we collect from you solely for the purpose of applying for a USI on your behalf as soon as practicable after the USI application has been made or the information is no longer needed for that purpose, unless we are required by or under any law to retain it. The personal information about you that we provide to the Registrar, including your identity information, is protected by the Privacy Act 1988 Cth (Privacy Act). The collection, use and disclosure of your USI are protected by the SI Act. If you ask to make an application for a student identifier on your behalf, will have to declare that has complied with certain terms and conditions to be able to access the online student identifier portal and submit this application, including a declaration that of Early Learning has given you the following privacy notice: is collected by the Registrar for the purposes of: applying for, verifying and giving a USI; resolving problems with a USI; and creating authenticated vocational education and training (VET) transcripts; may be disclosed to: Commonwealth and State/Territory government departments and agencies and statutory bodies performing functions relating to VET for: the purposes of administering and auditing Vocational Education and Training (VET), VET providers and VET programs; education related policy and research purposes; and to assist in determining eligibility for training subsidies; VET Regulators to enable them to perform their VET regulatory functions; VET Admission Bodies for the purposes of administering VET and VET programs; current and former Registered Training Organisations to enable them to deliver VET courses to the individual, meet their reporting obligations under the VET standards and government contracts and assist in determining eligibility for training subsidies; schools for the purposes of delivering VET courses to the individual and reporting on these courses; the National Centre for Vocational Education Research for the purpose of creating authenticated VET transcripts, resolving problems with USIs and for the collection, preparation and auditing of national VET statistics; researchers for education and training related research purposes; any other person or agency that may be authorised or required by law to access the information; any entity contractually engaged by the Student Identifiers Registrar to assist in the performance of his or her functions in the administration of the USI system; and will not otherwise be disclosed without your consent unless authorised or required by or under law. Privacy policies and complaints You can find further information on how the Registrar collects, uses and discloses the personal information about you in the Registrar s Privacy Policy or by contacting the Registrar by email at usi@industry.gov.au, or by telephoning the Skilling Australia Information line on 13 38 73, international enquiries +61 3 5454 5280. The Registrar s Privacy Policy contains information about how you may access and seek correction of the personal information held about you and how you may make a complaint about a breach of privacy by the Registrar in connection with the USI and how such complaints will be dealt with. You may also make a complaint to the Information Commissioner about an interference with privacy pursuant to the Privacy Act, which includes the following: misuse or interference of or unauthorised collection, use, access, modification or disclosure of USIs; and a failure by Us to destroy personal information collected by you only for the purpose of applying for a USI on your behalf. For information about how collects, uses and discloses your personal information generally, including how you can make a complaint about a breach of privacy, please refer to the Institute s privacy policy which can be found at www.goodstart.edu.au. 3 Contact details Email address Mobile number Phone number Street address Suburb State Postcode Postal address (if different from home address) Suburb State Postcode 3/8
4 Employment details Employer name Employer address Phone number Email address Of the following categories, which best describes your current employment status? Full time Part time Casual Not employed (not seeking employment) Not employed (seeking employment) Are you a Goodstart Early Learning Employee? If Yes, please enter your KRONOS number/employee ID: No Yes 5 Cultural background What nationality do you identify yourself as? (eg, Australian, British) In which country were you born? Which best describes your current citizenship/residency status? Please select one from the following: Australian citizen Australian permanent resident NZ Passport holder who has resided in Australia for 6 months or longer Other Current visa document holder. Please specify: If you have specified you were not born in Australia, please provide a Justice of the Peace-certified copy of your passport and visa, residency information, or proof of citizenship along with this Enrolment Application. What is the main language you speak at home? English Language other than English. If more than one language, indicate the one that is spoken most often: How well do you speak English? Very well Well Not well Not at all Are you of Aboriginal and/or Torres Strait Islander origin? Aboriginal Torres Strait Islander Both Neither 4/8
6 Disability Do you consider yourself to have a disability, impairment or long-term condition? No Yes If Yes, then please indicate the areas of disability, impairment or long-term condition. Select all that apply: Hearing/Deaf Physical Intellectual Learning Mental illness Acquired brain impairment Vision Medical condition Other please specify: 7 Education What is your highest completed school level? Tick one box only: Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or below Never attended school (please proceed to Previous Qualifications) In which year did you complete that school level? Are you still attending secondary school? No Yes Have you successfully completed any of the following qualifications? No Yes. If Yes, tick the applicable boxes below: Bachelor (or higher) Degree Advanced Diploma/Associate Degree Diploma (or Associate Diploma) Certificate IV (or Advanced Certificate/Technician) Certificate III (or Trade Certificate) Certificate II Certificate I Certificates other than the above. Please provide details for your qualifications below: Qualification gained Institution attended Year qualified Qualification gained Institution attended Year qualified Qualification gained Institution attended Year qualified 5/8
Do you wish to apply for credit transfers? No Yes If Yes, please provide a Justice of the Peace-certified copy of a relevant qualification with this Enrolment Application Form. 8 Reason for studying Of the following categories, which best describes your main reason for undertaking this course? Please tick one box only: To get a job To try for a different career To develop my existing business To start my own business It was a requirement of my job I wanted extra skills for my job To get into another course of study Other reasons please specify: Personal interest/self development 9 Language, Literacy and Numeracy (LLN) Good skills in reading, writing, oral language, and numeracy are necessary foundation skills required to be employed within the early learning sector, however it is not assumed that you, the learner, already possess these skills upon enrolment. It is the responsibility of all teaching and assessing staff to ensure they are considerate of individual learning needs when assessing, facilitating workshops and/or delivering content, and will adapt the learning and assessment methods to suit the individual needs of their learners. Please indicate below if you would like additional support from your Professional Learning Consultant in the following areas: Reading Writing Oral communication Learning Numeracy I do not require additional support in any of these areas Candidate name Candidate signature Date 6/8
10 Terms and conditions Enrolment into this program will be assessed on the information you have provided on this form. You will be notified by Student Services on the status of this application once your eligibility has been assessed. I acknowledge: 1. I have read the Student Guide located at goodstart.edu.au. 2. I have read the Institute s Privacy Statement located at goodstart.edu.au. 3. I have read the Notification of Collection Statement on page 8 of this enrolment application. 4. I may receive newsletters and other general communications via email which I may opt out of at any time. 5. As part of this program I am required to undertake vocational placement within a licenced early childhood education and care setting. 6. As part of this program I am required to provide a Certified Copy of a HLTAID004 Provide an emergency first aid response in an education and care setting first aid certificate by my enrolment s end date. This is to be sourced and paid for by me. 7. Information such as my academic progression, enrolment information, and results may be shared with government departments and/or my employer where it relates to legislative requirements. Declaration I understand the information I have supplied on this form is, to the best of my understanding and belief, complete and correct. I understand that the giving of false, incomplete, or misleading information may lead to the refusal of my application or cancellation of enrolment at any time. I give permission to obtain official records from any educational institution attended by me. I also authorise The to supply any relevant official records to education institutions to which I am seeking admission and to government bodies/institutions and to my employer. By signing this form I confirm that I have supplied all the relevant information required; I have read and understood the declaration above; and I accept the terms and conditions of this application. Candidate signature Date If candidate is under 18 years of age Parent/guardian signature Date If you have any questions about the enrolment application process, please contact the Institute on 1800 617 455, or email goodstart@goodstart.edu.au. 7/8
Notification of Collection Statement This is the Notification of Collection Statement that Goodstart Early Learning Limited ABN 69 139 967 794, trading as (The Institute) is required to provide you with at the time of obtaining your personal information. This forms part of The Institute s Privacy Policy, available at goodstart.edu.au. Purpose The Institute collects and holds personal information about you for the purposes of delivering training and assessment services under/in line with the VET Quality Framework for Registered Training Organisations (RTO). Sensitive Information In some circumstances The Institute may seek to collect personal information that is sensitive. This may include information such as any physical or mental illnesses or disabilities you may have, your language, and literacy and numeracy (LLN) level. We collect this information as it is reasonably necessary to enable The Institute to provide training and assessment services to cater for your individual needs and requirements. For example, you may have difficulty reading and/or writing and The Institute may need to provide additional assistance or tailored assessment methods to suit your needs. The Institute will only collect your sensitive information with your consent and will ensure that it is stored securely. If you do not wish for your sensitive information to be collected by The Institute, you should discuss this with a member of The Institute s Student Services team. The Institute s employees will act strictly in accordance with this policy and will be happy to discuss the reasons for seeking to collect your sensitive information. They will also discuss with you any consequences of not providing your sensitive information which may include an effect on the services The Institute can provide to you. Failure to Provide Information If you do not wish for your personal information to be collected you should discuss this with a Student Services team member. The Institute s employees will act strictly in accordance with The Institute s Privacy Policy and will be happy to discuss the reasons for seeking to collect your personal information. They will also discuss with you any consequences of not providing your personal information, or providing incomplete or inaccurate personal information, which may include an effect on what services The Institute can provide to you. Use and Disclosure The Institute will only use or disclose your personal information for the purpose it was collected or a reasonably expected or related secondary purpose. Personal information of students is ordinarily used or disclosed for the primary purposes of: providing training and assessment services; assessing eligibility of traineeships or apprenticeships; relevant State and Federal Government reporting of students and their academic progress were required under law; providing you with information about our organisation, and activities via letters, email, sms, telephone and other organisation communication channels; and requesting information from you about our organisation via surveys. We may disclose personal information about you to: third party service providers, who assist us in operating our business (including credit reporting bodies, collection agencies, legal advisors and technology service providers). We will take all reasonable steps to ensure these service providers do not breach the Australian Privacy Principles. These providers may be based overseas or use overseas infrastructure to perform services for us, including in the USA, Singapore and New Zealand a purchaser of the assets and operations of our business or a part of it, provided those assets and operations are purchased as a going concern (i.e. the purchaser buys the whole business of of Early Learning) State and Federal Government departments, ministries, agencies, councils, or authorities where reporting of students and their academic progression and results is required by law for The Institute to continue operating as a Registered Training Organisation (RTO). The Institute will not otherwise use or disclose personal information to a third party for any other purpose without your consent unless it is authorised or required by law. Access and Correction You may request access to your personal information. Ordinarily The Institute will require you to make a request for access in writing to the Privacy Officer. The Institute s employees other than the Privacy Officer are not generally able to provide you with access. If at any time you believe The Institute s record of your personal information is incorrect, please let The Institute know. We will take reasonable steps to correct the information so that it is accurate, complete and up to date. In some circumstance which are prescribed by the Privacy Act 1998 (Cth), such as where to do so might put a person at risk of harm or have an unreasonable impact on the privacy of others, The Institute may decline access to personal information. If your request for access is denied, The Institute may tell you why. Complaints and Feedback If you wish to make a complaint about a breach of the Privacy Act, Australian Privacy Principles or a privacy code that applies to us, please contact us as set out below and we will take reasonable steps to investigate the complaint and respond to you. If you are not happy with our response, you may complain directly to the Australian Information Commissioner. If you have any queries or concerns about our privacy policy or the way we handle your personal information, please contact the Privacy Officer at: Postal Address Attention: Privacy Officer PO Box 12089 George Street Brisbane Qld 4003 Email Address privacy@goodstart.edu.au Telephone +61 1800 617 455 More Information For more information about privacy in general, you can visit the Australian Information Commissioner s website at oaic.gov.au. 8/8