Name
*
First Name
Last Name
Middle Name
Date of Birth
*
MM
DD
YYYY
Title
*
Gender
*
Specify Gender
Concession Details
*
Concession Card Number
Card Expiry Date
MM
DD
YYYY
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone number
*
(###)
###
####
Email
*
Emergency contact phone number
*
(###)
###
####
Employment Status
*
Select the one which best describes your current employment status
Study Reason
*
Select the one which best describes your reason for studying
Are you of Aboriginal or Torres Strait Island origin?
*
In which country were you born?
*
Country other than Australia:
Language Spoken at home?
*
If you speak another language at home, how well do you speak English?
Other language spoken at home:
Highest school level completed
*
Previous qualifications achieved
Do you consider yourself to have a disability, impairment, or long-term condition?
*
Do you give permission for your photograph to be used for promotional purposes?
*
Will you participate in an Adult, Community & Further Education (ACFE) survey that assists us funding this course?
*
Student Declaration
*
I understand that Wellington & East Gippsland Learn Locals are required to provide the Victorian Government, through the Department of Education and Early Childhood Development, 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 www.education.vic.gov.au/training/providers/rto/Pages/datacollection.aspx). The Department may use the information provided to it for planning, administration, policy development, program evaluation, resource allocation, and 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 Learn Locals 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. I AM NOT enrolled in a school, including government, non-government, independent, Catholic or home school, and I am aged over 17 years of age, or under 17 years of age and have provided Evidence of Exemption by a school principal or the Department of Education and Training Regional Director. I acknowledge and understand that I may be contacted by the Department of Education and Training or an agent to participate in a survey, interview or other questionnaire.
