Select UnitCHCPRT001 Identify and respond to children and young people at riskHLTAID001 Provide cardiopulmonary resuscitationHLTAID003 - Provide first aidHLTAID004 - Provide an emergency first aid response in an education and care settingHLTAID006 - Provide advanced first aidTLIC1051A - Operate commercial vehicleTLIC3011 - Transport passengers with disabilitiesSIRXSLS406 - Manage sales and service deliverySITHCCC201 - Produce dishes using basic methods of cookerySITHCCC307 - Prepare food to meet special dietary requirementsTLIC1051A - Operate commercial vehicleTLIC3011 - Transport passengers with disabilitiesIf unit is not in list, Please write in below
ENTER INDIVIDUAL UNIT DETAIL
Unit Name
PERSONAL and CONTACT DETAILS
Given Name (required)
MIDDLE NAME
SURNAME(required)
Date of Birth
NATIONALITY:(required)
Your Email
HOME CONTACT PHONE /Mobile :
Mobile:
AGE AT TIME OF ENROLLMENT 15-1920-2425 +
SEX (required) MALEFEMALE
UNIT NUMBER:
STREET NUMBER:
STREET NAME:
SUBURB:
STATE:
POSTCODE:
NEXT OF KIN/EMERGENCY CONTACt
NAME:
RELATIONSHIP:(required)
Relative Phone No.
Are you new to the Victorian Education system or do not have your Victorian Student Number?
Select VSN YesNoYes
VICTORIAN STUDENT NUMBER (VSN)
If you are aged 24 or below at time of enrolment, please provide your Victorian Student Number:
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) Full Time EmployeeUnemployed-seeking full time workPart Time EmployeeSelf Employed–Not employing othersUnemployed-seeking part time workEmployerEmployed-Unpaid worker in Family BusinessNot employed-not seeking employment
Employer Name (If applicable)
Employer Address (If applicable)
OCCUPATION IDENTIFIER (VIC): ManagerTechnicians and Trades WorkersLabourersCommunity and Personal Service WorkerClerical and Administrative WorkersOtherMachinery Operators and DriversProfessionals
INDUSTRY OF EMPLOYMENT (VIC): Agriculture, Forestry and FishingMiningElectricity, Gas, Water and Waste ServicesFinancial and Insurance ServicesRetail TradeAccommodation and Feed ServicesTransport, Postal and WarehousingWholesale TradeInformation Media and telecommunicationsRental, Hiring and real Estate ServicesEducation and TrainingProfessional, Scientific and Technical ServicesAdministrative and Support ServicesConstructionPublic Administration and SafetyHealth Care and Social AssistanceManufacturingArts and recreation ServicesOther Services
SCHOOLING DETAILS
ARE YOU STILL ATTENDING SECONDARY SCHOOL? YesNo
WHAT IS YOUR HIGHEST COMPLETED SCHOOL LEVEL? Never attended schoolYear 8 or lowerYear 9 or equivalentCompleted Year 10Completed Year 11Completed Year 12
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:
CITY OF BIRTH:
if ON VISA/TEMP PERMIT STATE CODE / DESCRIPTION AUSTRALIAN CITIZENAUSTRALIAN RESIDENTVISA/TEMP PERMIT
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)
Certificate ICertificate IICertificate III (or Trade Certificate)Certificate IV (or Advanced Certificate/Technician)Diploma (or Associate Diploma)Advanced Diploma or Associate DegreeBachelor Degree or Higher DegreeCertificates other than the above
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) VisionIntellectualMedical ConditionHearing/DeafMental IllnessLearningPhysicalAcquired Brain ImpairmentOther
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. To develop my existing businessTo start my own businessTo get a better job or promotionTo get into another course of studyTo try for a different careerTo get a jobIt was a requirement of my jobI want extra skills for my jobFor personal Interest or self- developmentOther
CONCESSION ELIGIBILITY ARE YOU ELIGIBLE FOR CONCESSION? YesNo
If Yes, Please Specify Low Income/Special BenefitFamily Allowance/Single ParentYouthNew-startSickness AllowanceAge/Carer/Disability/Partner/Widow/WifeOther
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
STUDENT NAME
If the applicant is under 18 years of age
PARENT/GUARDIAN NAME
Upload ID's 100 point (Passport/Driving License & Medicare)
