STUDENT

ENROLMENT FORM

All prospective students are to complete this enrolment form. Please print in black or blue pen.

This form must be submitted in person to MONASH Training and Professional Development along with any supporting documents required.

NOTE: No enrolment will be processed unless this form is fully completed and the declaration is signed to indicate your understanding and agreement with all conditions.

Section 1: Course Information

DATE OF APPLICATION:

COURSE CODE AND NAME:(Course you are enrolling into)

COURSE STREAM/TIMETABLE:(Course you are enrolling into)

TICK IF YOU WISH TO APPLY FOR:

RPL OR CREDIT TRANSFER

Please see the Student Information Handbook for details.

Unique Student Identifier (USI) Number:

Section 2: Student Details

Surname:

First Name:

Middle Name:

Preferred Name:

Date of Birth: ____ /____ /____ dd mm yy

Gender: Male Female (Indeterminate/Intersex/Unspecified)

Phone:

Mobile:

Email:

What is the address and postcode where you usually live? (Street Number and Name not Post Office box)

Building / Property Name:

Flat / Unit Number:

Street Number:

Street Name:

Suburb:

Postcode:

Postal Address: What is your postal address? (If different from above)

Building / Property Name:

Flat / Unit Number:

Street Number:

Street Name:

Suburb:

Postcode:

Section 3: Background

Of the following categories, which BEST describes your current employment status? (Tick ONE box only)

Full-time employee

Self-employed – not employing others

Employed – unpaid worker in a family business

unemployed – seeking part-time work

Part-time employee

Employer

Unemployed – seeking full-time work

not employed – not seeking employment

In which country were you born? Are you an Australian citizen or permanent resident? Australia Other_____________ Yes No

City / Town of Birth: __________________ If ‘No’ specify nationality: __________________

Are you of Aboriginal or Torres Strait Islander origin?

No Yes, Aboriginal Yes, Torres Strait Islander (For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes.)

Do you speak a language other than English at home? No, English only

Yes, other – Please specify: ________________

(If more than one language, indicate the main language spoken)

How well do you speak English?

Very well Well Not well Not at all

Section 4: School Details

Are you still attending secondary school?

Yes No

What is your highest COMPLETED school level?

Year 12 Year 11 Year 10

Year 9 or equivalent Year 8 or lower

Never attended school

In which YEAR did you complete that school level?

Name of most recent secondary school attended:

Section 5: Disability

Do you consider yourself to have a disability, impairment or long-term condition?

Yes No If Yes, please indicate the areas of disability, impairment or long-term condition.(You may indicate more than one)

Hearing/deaf

Physical

Intellectual

Learning

Mental Illness Other

Acquired brain impairment

Vision Medical condition

Section 6: Prior Education

Have you SUCCESSFULLY completed any of the following qualifications? Yes No

If ‘Yes’ please enter ONE of these Prior Education Achievement Recognition Identifiers ANY applicable qualification level.

A – Australian E - Australian Equivalent I – International

A E I

Bachelor Degree or Higher Degree

Advanced Diploma or Associate Degree

Diploma (or Associate Diploma)

Certificate IV (or Advanced Certificate/Technician)

Certificate III or Trade Certificate

Certificate II

Certificate I

Certificates other than those listed

Section 7: Skills Victoria AVETMISS

Which of the following classifications BEST describes the industry of your current or previous Employer (Tick ONE box only) If never employed go to School details.

A- Agriculture, Forestry and Fishing

K - Financial and Insurance Services

L - Rental, Hiring and real Estate Services

M - Professional, Scientific and Technical Services

N - Administrative and Support Services

O - Public Administration and Safety

P - Education and Training

Q - Healthcare and Social Assistance

R - Arts and Recreation Services

S - Other Services __________________

B - Mining

C - Manufacturing

D - Electricity, Gas, Water and Waste Services

E - Construction

F - Wholesale Trade

G - Retail Trade Services

H - Accommodation and Feed

I - Transport, Postal and Warehousing

J - Information Media and Telecommunications

Which of the following classifications BEST describes your current or recent occupation? (Tick ONE box only) If never employed proceed to school details. 1 - Manager

6 - Sales Workers

7 - Machinery Operators and Drivers

8 - Labourers

9 - Other __________________________

2 - Professionals

3 - Technicians and Trade Workers

4 - Community and Personal Service Workers

5 - Clerical and Administrative Workers

Section 8: Victorian Student Number – to be completed by students aged 24 years and below

Enter your Victorian Student Number:

Have you attended any Victorian school since 2009 or done any training with a vocational education and training (VET) registered training organisation or an Adult and Community Education provider in Victoria since 2011?

No – I have not attended a Victorian school since 2009 or a TAFE or other VET training provider since the beginning of 2011.

Yes – I have attended a Victorian school since 2009:

Most recent Victorian school attended: ____________________________________________

And/or

Yes – I have participated in training at a TAFE or other training organisation since the beginning of 2011. List the most recent training organisations with which you have participated in training in Victoria since 2011:

1. ________________________________________

2. ________________________________________

3. ________________________________________

Please provide details of these courses (if applicable):

EXAMPLE: - BSB30412 Certificate III in Business Administration, Monash Training and Professional Development

1.

2.

Section 9: Demographic Data

Of the following categories, which BEST describes your main reason for undertaking this course?

(Tick ONE box only)

To get a job

To start my own business

To get a better job or promotion

I wanted extra skills for my job

For personal interest or self-development

To develop my existing business

To try for a different career

It was a requirement of my job

To get into another course of study

Other reasons

How did you hear about us?

Local Library

School Career Advisor

my.monash portal

Other ______________

Mailout

Monash Faculty

Open Day

Employer/Agency

Community Centre

Facebook

Website

Brochure on Campus

Are you a Monash university staff member?

Yes No

Are you a Monash university student?

Yes - Undergrad Yes - Postgrad No

Which campus are you located at? _____________

Which Faculty? ____________________

Section 10: Fees

Please refer to the 2017 Indicative Student Tuition Fees list which can be obtained from our website or by contacting our office.

Are you applying for government funding (Victorian Training Guarantee funding)?

YES NO

If Yes – Complete the Victorian Guarantee 2017 Evidence of Eligibility and Student Declaration form.

If you are eligible for a concession rate (health care card) please complete your details below:

Type of concession card: ____________________________

Card Number: ____________________________ Expiry Date: __________

If you are applying for a concession we will need to take a photocopy of the original card when you enrol.

Payment method: Cash Cheque Card Invoice

Will you require a payment plan? Yes (plus $2 once off set up fee) No

Credit Card Details: Visa MasterCard

Card Number: Expiry Date: /

Cardholder Name: _____________________________ Signature: ________________________

Total to be paid: $__________________

Deposit Payment: $__________________

Remaining fees: $____________________

Staff signature: _________________ Date: ________________________

Section 11: Privacy Statement & Declarations

Privacy Statement

Please read the information below and sign if you agree to how your personal information may be used:

I understand that:

Monash Student Association is required to provide the Victorian Government, through the Department of Education and Training, with student and training activity data this includes information I provide in this enrolment form. Information is required to be provided in accordance with the Victorian VET Student Statistical Collection Guidelines (which are available at htpp://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.

The Education and Training Reform Act 2006 requires Monash Student Association 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 Monash Student Association’s Privacy Officer on 9905 3180 or email msa-monashtraining@monash.edu.

The Victorian Government, through the Department of Education and Training (the Department), develops, monitors and funds vocational education and training (VET) in Victoria. The Victorian Government is committed to ensuring that Victorians have access to appropriate and relevant VET services. Any personal information collected by the Department for VET purposes is protected in accordance with the Privacy and Data Protection Act 2014 (Vic) and the Health Records Act 2001 (Vic).

Collection of your data

MONASH Training and Professional Development is required to provide the Department with student and training activity data. This includes personal information collected in the [RTO] enrolment form and unique identifiers such as the Victorian Student Number (VSN) and the Commonwealth’s Unique Student Identifier (USI).

MONASH Training and Professional Development provides data to the Department in accordance with the Victorian VET Student Statistical Collection Guidelines, available at: http://www.education.vic.gov.au/training/providers/rto/Pages/datacollection.aspx.

Use of your data

The Department uses student and training data, including personal information, for a range of VET purposes including administration, monitoring and planning.

A student’s USI may be used for specific VET purposes including the verification of student data provided by [RTO]; the administration and audit of VET providers and programs; education-related policy and research purposes; and to assist in determining eligibility for training subsidies.

Disclosure of your data

As necessary and where lawful, the Department may disclose VET data, including personal information, to its contractors, other government agencies, professional bodies and/or other organisations for VET-related purposes. In particular, this includes disclosure of VET student and training data to the Commonwealth and the National Centre for Vocational Education Research (NCVER).

Legal and Regulatory

The Department’s collection and handling of enrolment data and VSNs is authorised under the Education and Training Reform Act 2006 (Vic). The Department is also authorised to collect and handle USIs in accordance with the Student Identifiers Act 2014 (Cth) and the Student Identifiers Regulation 2014 (Cth).

Survey participation

You may be contacted to participate in a survey conducted by NCVER or a Department-endorsed project, audit or review relating to your training. This provides valuable feedback on the delivery of VET programs in Victoria.

Consequences of not providing your information

Failure to provide your personal information may mean that it is not possible for you to enrol in VET and/or to obtain a Victorian Government VET subsidy

Access, correction and complaints

You have the right to seek access to or correction of your own personal information. You may also complain if you believe your privacy has been breached.

For further information, please contact Monash Training and Professional Development’s office in the first instance by phone (03) 9905 53180 or msa-monashtraining@monash.edu

Further information

For further information about the way the Department collects and handles personal information, including access, correction and complaints, go to: http://www.education.vic.gov.au/Pages/privacypolicy.aspx.

For further information about Unique Student Identifiers, including access, correction and complaints, go to: http://www.usi.gov.au/Students/Pages/student-privacy.aspx.

I acknowledge that I have read the Victorian Government’s VET Student Enrolment Privacy Notice.

Signature: _____________________________________________ Student Name: _____________________________________________Date: ___________

Section 12: Unique Student Identifier (USI) Number

If you do not already have a Unique Student Identifier (USI) and you want Monash Training and Professional Development to apply for a USI to the Student Identifiers Registrar (Registrar) on your behalf, MONASH Training and Professional Development will provide to the Registrar the following items of personal information about you:

· Your name, including first or given name(s), middle name(s) and surname or family name as they appear in an identification document;

· Your date of birth, as it appears, if shown, in the chosen document of identity;

· Your city or town of birth;

· Your country of birth;

· Your gender; and

· Your contact details.

I acknowledge and agree to the terms described in this privacy statement.

Signature: _____________________________________________ Student Name: _____________________________________________Date: __________

Conditions

In completing this enrolment form the student is agreeing to a contract with MONASH Training and Professional Development that stipulates the following:

· Once the student commences the nominated course, MONASH Training and Professional Development will deliver the Training Program using competency based training principles and practices in accordance with the AQTF (Australian Quality Training Framework)

· MONASH Training and Professional Development and the student agree to work together to produce a unified approach in the student achieving the relevant qualification.

· Consenting to MONASH Training and Professional Development to pass on the above information to the Student Identifiers Registrar so we can apply for a unique student identifier on the student’s behalf.

· The course fees payable to MONASH Training and Professional Development are for the provision of the following services:

· Training and Assessment

· Ongoing Administration Processes

· Certification/Statement of Attainment

· Where a student has undertaken an assessment and it has been marked as ‘Not yet Competent’ (NYC), they be allowed to re-sit the test/or have a re-assessment. If they are deemed ‘NYC’ for a second time they are to re-enrol into that unit/ subject. This will include re-training and therefore a re-enrolment fee for the unit will apply.

· For re- issuance of Certificates and Statements of Attainments the student will be charged $22 per document required. Payment for the re-issuance of such documents is required prior to the re-issuance occurring.

· MONASH Training and Professional Development reserves the right to accept or reject any application for enrolment at its discretion.

· MONASH Training and Professional Development reserves the right to cancel any course prior to the commencement date of the course should it deem it necessary and in that event, shall refund all payments received from the student (see refund policy).

Student Declaration

In signing and submitting this ‘Enrolment Form’ and this declaration section the student acknowledges:

· That the information provided by the student in this enrolment form is complete and correct.

· That providing any false information and / or failing to disclose any information relevant to my application for enrolment and / or failure to complete an application / enrolment form may result in the withdrawal of any offer, particularly as it relates to my eligibility to obtain an offer for government subsidised training, and / or cancellation of enrolment at the discretion of MONASH Training and Professional Development.

· Agrees to be bound by the MONASH Training and Professional Development rules and regulations and any amendments made to the rules and regulations.

· Agrees to undertake Language, Literacy and Numeracy testing requirement prior to acceptance into any course entry and adhere to any other pre-requisites identified through the enrolment process.

· Where a student’s contact details change while studying with MONASH Training and Professional Development the student must advise MONASH Training and Professional Development of these changes within 7 days. These details include but are not limited to details such as e-mail, address, and contact phone details.

· If my enrolment is funded by HESG, then I confirm that the information I have given in relation to my eligibility is true and correct and I will show MONASH Training and Professional Development original certificates or other evidence as required and that they may take copies of these and release them to HESG as a part of their audit process.

· The Student Information Handbook has been read and understood.

· Agrees to the Enrolment Conditions (listed above in this document)

· Payment is attached for enrolment into this course as outlined in this enrolment form/ has been made for the course

Signature: _____________________________________________ Student Name: _____________________________________________Date: __________

OFFICE USE ONLY – Statement of Fees

MONASH Training and Professional Development (TOID 21526), ph. 9905 3180

Student Name:

Course Duration (nominal hours):

Course Code: Course Title:

Mode of delivery: Classroom Online Blended

Location: Clayton Caulfield Berwick Peninsula Workplace

Work placement required? Yes, number of hours: ________ No

Third party providers: Healthguard First Aid (ph. 9729 0101) Not applicable

Currency of training product?

Current Superseded

Additional educational/support to be provided:

___________________________________________________

Eligible for Government Funding? Yes, Government contribution: $____________ No

Eligible for Concession? YES NO

Total Fees Payable: $__________________

OFFICE USE ONLY – Payments

Payment method: Cash Cheque Card Invoice

Credit Card Details: Visa MasterCard

Card Number: Expiry Date: /

Cardholder Name: _____________________________ Signature: ________________________

Deposit Payment

Amount Paid: $____________________ Date: _______________ Staff signature: _________________

Payment Plan Details:

Due Date

Instalment Amount

Payment Received

Student Authorisation

I ______________________________ authorise MONASH Training and Professional Development to charge my credit card for my payment plan instalments as outlined in the payment plan above. I agree to ensure that sufficient credit is available on my card for each of the payments to be processed and I understand that a default on any one or more payments may result in my enrolment being suspended.

Student Signature: _____________________________________ Date: ______________________

Staff Signature: ________________________________________ Date: ______________________

Student Enrolment Form Version 5.1 December 2016 | Page 5