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Course Information

   

   

STUDENT ENROLMENT FORM

Student Details
Title:
First Name: 
 Middle Name(s): 
 Last Name: 
Date of Birth: 
 Gender:
 Work Phone: 
Mobile Phone: 
 Email:

Emergency Contact

Full Name: 
 Phone: 
Mobile Phone: 

Home Address/Mailing Address

Address 1: 
Address 2: 
City/Suburb: 
State: 
 Post Code:

Current Employer Details
Business Name: 
Contact:
Phone:
 Email:
Address 1:
Address 2:
City/Suburb: 
State:
 Post Code:
1. Employment Details
Which of the following categories best describes your current employment status?
Select One
2. Home Language
Do you speak a language other than English at home?
Select One
3. How well do you speak english?
Select One
4.How well do you write English?
Select One
5. Do you identify with Aboriginal or Torres Strait Islander Origin?
Select One
6. Secondary Education
What is your highest completed secondary school level?
Select One
In which year did you complete that school level?
7. Special Needs
Do you consider yourself to have a disability, impairment or long term condition?
Select One
If yes, then please indicate the areas of disability, impairment or long term condition.
Select One or More
8. If you answered YES to the above question, will you need any special assistance, because of the disability?
Select One or More
9. Post Secondary Education
Have you successfully completed any of the following qualifications?
If yes, tick any applicable boxes.
10. Declaration
I accept responsibility for the accuracy of my enrolment record.
I also acknowledge that, I am subject to the statutes, regulations and rules of the AQTF Training Guidelines.
I give permission for my results to be released to employers or other authorised persons.
I give permission to Intertag Pty Ltd to use my course photograph and/or testimonial for marketing purposes.

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