Course Registration

Select Your Course

Student Details

Surname

First Name

Preferred Name

Date of Birth 

Gender Gender Female Male Other

Citizenship

Citizenship Comment

Were you born in Australia Were you born in Australia Yes No

If no, what country were you born?

Do you Identify as Do you Identify as Aboriginal South Sea Islander Torres Strait Islander Other (comment below)

Identify As Comment

Do you consider yourself to have a disability, impairment or long term condition? Do you consider yourself to have a disability, impairment or long term condition? No Yes

If yes, please indicate the areas of disability, impairment or long term condition: If yes, please indicate the areas of disability, impairment or long term condition: Hearing/Deaf Physical Intellectual Learning Acquired Brain Impairment Vision Medical Condition Mental Illness

Language

Do you speak a language other than English at home? Do you speak a language other than English at home? No, English Only Yes

If yes, please specify?

How well do you speak English?

Is English language assistance required? Is English language assistance required? No Yes

Mobile Phone

Home Phone

Work Phone

Street Address

City/Suburb

Postcode

Is your postal address the same as your street address? Is your postal address the same as your street address? Yes No

Are you living in Social Housing? Are you living in Social Housing? No Yes N/A

Employment (if applicable)

Occupation

Employer

Contact

Address

City/Suburb

State

Postcode

Phone

Fax

Of the following categories, which best describes your current employment status?

Have you been unemployed for longer than 6 months? Have you been unemployed for longer than 6 months? No Yes

Please provide details of any supplementary welfare (if applicable)

Employment Service Provider name (if you have one)

Employment Service Provider Client ID (if you have one)

Schooling

What is your highest completed school level? What is your highest completed school level? Year 12 Year 11 Year 10 Year 9 or equivalent Year 8 or lower Did not go to school

In which year did you complete that level?

Are you still attending secondary school? Are you still attending secondary school? Yes No

School

If yes, please provide the year level

Contact

City/Suburb

Address

State

Postcode

Previous Qualifications Achieved

Have you undertaken any other Smart & Skilled training this year? Have you undertaken any other Smart & Skilled training this year? Yes No

If yes, what Smart & Skilled training have you completed?

Have you successfully completed any of the following qualifications? Have you successfully completed any of the following qualifications? Yes No

Tick any applicable Tick any applicable Bachelor Degree or Higher Degree Advanced Diploma or Associate Degree Certificate IV Certificate III (or Trade Certificate) Certificate II Certificate I Certificates other than above

USI (Unique Student Identifier)

Do you have a USI? Do you have a USI? I DO HAVE a USI I DO NOT have a USI

My USI is

You can apply for a USI and provide it to Learned prior to commencing my course at www.usi.gov.au

By completing this enrolment form you consent to using your personal information to verify your USI.

Media Release

I authorise LearnEd, to use or reproduce material that may include my image for the purpose of:

- Reporting ‘Good News’ stories to Government and funding bodies

- Promotion of Learned as a business, services and projects

The use of photographic material, student statement or information that includes or makes reference to, whole or in part, my personal information is restricted to use by Learned, and such use will be in accordance with current privacy legislation and the company’s Privacy Policy and will not be used by third parties without my consent.

I agree I agree Yes No

Identification

Please upload a photo of your drivers licence or Passport Please upload a photo of your drivers licence or Passport

Please upload a photo of your Medicare card Please upload a photo of your Medicare card

Please upload a photo of your Concession Card (if applicable) Please upload a photo of your Concession Card (if applicable)

Declaration

By completing this on-line enrolment application form, I certify that the particulars herein are true and correct and agree to the following: The terms and conditions located in the Learned Student Handbook. Inclusive of all policies, procedures, funding and fee requirements. The program structure and the items listed within the Course Guide. Agree to complete a Tuition Fee Payment Plan. Provide evidence of Identification, and any & all additional requested items such as concession evidence. Have been provided the relevant USI Privacy Notice. Have been provided the Privacy Notice relevant to my studies. Consent to Learned utilising information for the purposes of the Smart & Skilled Calculator (NSW Students Only) If you are under the age of 18 the signature of your Parent/Guardian is required. Please see student forms on our website for the Parental Approval form or contact Learned.

Electronic Signature Consent Electronic Signature Consent By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper.

Student Consent Student Consent I agree to the Student Declaration as stated on the Learned Enrolment Form

9 + 11 =