PERSONAL and CONTACT DETAILS

Given Name (required)

MIDDLE NAME

SURNAME(required)

Date of Birth

NATIONALITY:(required)

Your Email (required)

HOME CONTACT PHONE: (required)

Mobile:

AGE AT TIME OF ENROLLMENT (required)
15-1920-2425 +

SEX (required)
MALEFEMALE

UNIT NUMBER:

STREET NUMBER:

STREET NAME:

SUBURB:

STATE:

POSTCODE:

NEXT OF KIN/EMERGENCY CONTACt

NAME:

RELATIONSHIP:

Mobile:

VICTORIAN STUDENT NUMBER (VSN)

If you are aged 24 or below at time of enrolment, please provide your Victorian Student Number:

Are you new to the Victorian Education system or do not have your Victorian Student Number?

Select VSN (required)
YesNoYes

UNIQUE STUDENT IDENTIFIER (USI)

As of January 1st 2015, all candidates undertaking VET training in Australia must have a Unique Student Identifier (USI).Do you have or have your ever been issued a USI?

If you answered “No/Not sure” above, you must complete the details of “FORM 55 STUDENT CONSENT FORM” in order for RTO to apply for a USI on your behalf.

YesNo

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

Select One (required)

Employer Name (If applicable)

Employer Address (If applicable)

OCCUPATION IDENTIFIER (VIC): (required)

INDUSTRY OF EMPLOYMENT (VIC): (required)

SCHOOLING DETAILS

ARE YOU STILL ATTENDING SECONDARY SCHOOL?
YesNo

WHAT IS YOUR HIGHEST COMPLETED SCHOOL LEVEL?

IN WHICH YEAR DID YOU COMPLETE THAT SCHOOL LEVEL?

(e.g.if you finished school when you were 15, add 15 to the year you were born, 15+168 = 1983)

AUSTRALIAN RESIDENCY STATUS

COUNTRY OF BIRTH:(required)

CITY OF BIRTH:

if ON VISA/TEMP PERMIT STATE CODE / DESCRIPTION

LANGUAGE

DO YOU SPEAK ANOTHER LANGUAGE OTHER THAN ENGLISH AT HOME?
YesNo
Write your langugae If yes

HOW WELL DO YOU SPEAK ENGLISH?
Very WellWellNot WellNot at All

HAVE YOU SUCCESSFULLY COMPLETED ANY OF THE FOLLOWING QUALIFICATIONS?
YesNo

NO (GO TO NEXT QUESTION)

DISABILITY
DO YOU CONSIDER YOURSELF TO HAVE A DISABILITY, IMPAIRMENT OR LONG TERM CONDITION?
YesNo

If Yes, Please indicate the areas of disability, impairment or long-term condition:
(You may indicate more than one)

PLEASE INDICATE ANY SPECIAL NEEDS/ASSISTANCE YOU MAY REQUIRE IN RELATION TO YOUR DISABILITY

ATSI STATUS
ARE YOU OF ABORIGINAL OR TORRES STRAIT ISLANDER ORIGIN?(For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes.)
NoYes, AboriginalYes, Torres Strait Islander

REASON FOR STUDY
PLEASE TICK WHICH OF THE FOLLOWING CATEGORIES BEST DESCRIBES YOUR MAIN REASON FOR UNDERTAKING THIS COURSE/TRAINEE SHIP/APPRENTICESHIP.

CONCESSION ELIGIBILITY
ARE YOU ELIGIBLE FOR CONCESSION?
YesNo

If Yes, Please Specify

PRIVACY STATEMENT –I UNDERSTAND THAT

.The STAC is 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 enrollment form. Information is required to be provided in accordance with the Victorian VET Student Statistical Collection Guidelines (which are available at http://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, 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

.I acknowledge that I have a right to access personal information which STAC hold about me, subject to exceptions in relevant privacy legislation. I understand that I can obtain further information about STAC in the Student Handbook

.The Education and Training Reform Act 2006 requires STAC 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 us on phone 1300 34 76 76 or email training@stac.edu.au

.I acknowledge and agree to the terms described in the privacy statement

If the applicant is 18 years of age and over

Digital Signature - STUDENT NAME

If the applicant is under 18 years of age

PARENT/GUARDIAN NAME

Upload ID's 100 point (required)(Passport/Driving License & Medicare)

Upload ID's 100 point (Passport/Driving License & Medicare)

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