Enrol Now 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* Select Value Dr Mr Mrs Ms 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: Select Value Hearing Learing Medical Mobility Other Vision 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 Select Value II III IV in Diploma of Other qualifications: : Employment Status* Select Value Full-Time Employee Other Part-Time Employee Self-Employed Unemployed - Not seeking employment Unemployed - Seeking Full-time work Unemployed - Seeking Part-time work if other please specify: Employer's name & address Reason for doing course* Select Value For personal interest or self-development I wanted extra skills for my job It was a requirement for my job Other To develop my existing business To get a better job or promotion To get a job To get into another course of study To start my own business To try a different career if other please specify: * Denotes required fields