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CHOSEN COURSE

Course Number

Course Name

Enrolment ID

Enrolment Date

PERSONAL DETAILS (legal name as shown on passport or driver's licence)

Unique Student Identifier (USI)*

Title*

Surname*

First Name*

Middle Name

Preferred Name*

Residential Address*

Residential Town / Suburb*

Residential State*

Residential Post Code*

Residential Country*

Postal Address as above?

Postal Address*

Postal Town / Suburb*

Postal State*

Postal Post Code*

Postal Country*

Date of Birth (DD/MM/YYYY)*

Gender*

FemaleMale

Home Phone*

Work Phone

Mobile*

Email*

VOCATIONAL EDUCATION INFORMATION

Town / City of Birth*

Country of Birth*

Nationality*

Language spoken at home*

How well do you speak English?*

Not at allNot wellVery wellWell

Do you require language or lieracy assistance?*

NoYes

Are you of Aboriginal or Torres Strait Islander decent?*

NoYes
if yes which?

Do you have a disability, impairment or long term medical condition?*

NoYes
if yes please specify:

other:

EDUCATIONAL HISTORY

Highest school level (i.e. year 12)*

Calendar year completed (i.e. 2013)*

Currently attending seccondary school?*

NoYes

LUI Number

PRIOR EDUCATIONAL ACHIEVEMENTS (completed)

Certificate in

Diploma of

Other qualifications: :

Employment Status*

if other please specify:

Employer's name & address

Reason for doing course*

if other please specify: