Enrolment - ACE North Coast

Selected Course(s):

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Course	Day	Time	Fee
/			$
		TOTAL:	$0

Enrolment Application Form:

* indicates required field

First Name: *

Last Name: *

Email: *

Postal Address

Postal Address: *

City: *

Postcode: *

Home Address

Same as Postal Address

Home Address:

City:

Postcode:

Phone

Daytime: *

Home:

Mobile:

Fax Number:

Personal information

Date of Birth: / / *

Sex (M or F): M F *

Survey Information:

In which country were you born?

Australia
Other, please specify

Are you of Aboriginal or Torres Strait Islander descent?

No
Yes, Aboriginal
Yes, Torres Strait Islander
Yes, both Aboriginal & Torres Strait Islander

What language do you usually speak at home?

English
Other, please specify

What best describes your current employment situation?

Full-time employee
Part-time/casual
Self employed
Employer
Unemployed - seeking full-time work
Unemployed - seeking part-time work
Unpaid worker in a family business
Not employed - not seeking employment

Which year of school is the highest you have completed?

Year 8 or below
Year 9 or equivalent
Year 10 or equivalent
Year 11 or equivalent
Year 12 or equivalent
Still at school
Did not go to school

Have you completed any further education?

No
Certificate I
Certificate II
Certificate III
Certificate IV
Diploma
Advanced Diploma
Bachelor Degree or higher

Do you have a significant disability?

No
Physical disability
Learning disability
Intellectual disability
Visual impairment
Hearing impairment
Mental illness
Medical condition

Do you require special assistance on wheelchair access as a result of the above disability?

Yes No

Reason for enrolling?

Get a job
Extra skills for current job
Required by employer
Better job or promotion
Change career
Start a new business
Develop existing business
Proceed to another course
Personal interest/selfdevelopment

Concession Details

Card No:

Student at:

Student No:

Type/Reason:

Payment Details

Choose how to pay

Pay Now (credit card via PayPal)
Pay in Person (cash, cheque, eftpost or credit card)
Pay over Phone (credit card)
Pay by Mail (cheque)

Privacy Statement:

Information concerning students is collected for identification, communication and other administrative purposes, for programme evaluation, and to meet state and national reporting requirements. Student information will be kept safe while in the possession of the organisation and securely disposed of when no longer required. Students may view personally relevant information held by the organisation upon request. In addition, personal information may be passed on to the NSW Board of Adult and Community Education and the National Centre for Vocational Education Research for statistical analysis and research, student surveys or other evaluative purposes. We appreciate and encourage student participation in such research. Tick the box below marked "I accept" to indicate your acceptance of this. If you do not wish your details to be passed on to these agencies for such purposes, please tick the box below marked "I decline".

I accept I decline

Terms & Conditions:

I have read and agree to the Terms & Conditions.