CHC33021 Certificate III in Individual Support Enrolment Form CHC33021 Certificate III in Individual Support Enrolment Form Personal Information Title * Mr Mrs Ms Miss Date * Name * Name Family Name Family Name Given Names Given Names Date of Birth * Age * Gender * Male Female Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Australia Country Phone * Email * Identification: Do you have a Unique Student Identifier? If so please fill it here * Effective from 1 January 2015, all students enrolled in nationally recognised training, will be required to provide their registered training organisation (RTO) with their USI and date of birth. Registering for a USI is simple and the registration process is available online and at no cost to the student. This USI will stay with the student for life and be recorded with any nationally recognised VET course that is undertaken. Students can now create a USI by following the process below: Log on to http://portal.usi.gov.au/student When applying for a USI, students will be required to supply one of the following valid Australian forms of ID: Driver’s Licence Medicare Card Australian Passport Visa (with Non-Australian Passport) Birth Certificate (Australian) Certificate Of Registration By Descent Citizenship Certificate Language and cultural diversity 1. In which country were you born? * Australia Outside Australia If select Outside Australia, Please Specify * 2. Are you an Australian Citizen or New Zealand Citizen or Australian Permanent resident? * Yes No If No specify what visa sub type you are on? * 3. Do you speak a language other than English at home? * No, English only Yes Please Specify * 4. How well do you speak English? * Very Well Well Not Well Not at all 5. Are you of Aboriginal or Torres Strait Islander origin? * No Yes, Aboriginal Yes, Torres Strait Islander Both, Aboriginal & Torres Strait Islander 6. Do you consider yourself to have a disability, impairment or long-term condition? * Yes No If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list: * Hearing/deaf Physical Intellectual Learning Mental illness Acquired brain impairment Vision Medical condition OtherOther You may indicate more than one area 7. What is your highest COMPLETED school level? * Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or below 8. Are you still attending secondary school? * Yes No In which YEAR did you complete that school level? * 9. Have you SUCCESSFULLY completed any of the following qualifications? * Yes No 10. If YES, then tick ANY applicable boxes. * 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 the above If you have ticked any of the above boxes, please state the name of your qualification/s * 11. Of the following categories, which BEST describes your current employment status? * 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 12. Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship? * To get a job To develop my existing business To start my own business To try for a different career To get a better job or promotion It was a requirement of my job I wanted extra skills for my job To get into another course of study For personal interest or self-development To get skills for community/voluntary work Other reasonsOther reasons Other Information How did you learn about Health Courses? * Website Exhibition Advertisement Others Payment Option * 2 Monthly payments of $1150 Deposit of $1000 and 30 weekly payments of $ 50 I agree to these Terms of Enrolment. * Agree Submit If you are human, leave this field blank.
