new student personal details form (PDF, 242 KB)

Student - Personal DetailsTraining Subsidy - Certificate III"Anything is possible with TAFE"PLEASE provide an answer to all questions on this form - please use block letters1. Student detailsTAFE Student Number (if known)USI Code (if known)Learner Unique Identifier (if known)First Name Middle Name/s Last Name(The name/s recorded above should be as it appears on your birth certificate/passport. This will be used for all official purposes such as fee concession validation, and will also appear on result/awards issued.)Preferred Name (if different from above) Previous Last Names (if any e.g. maiden name)Date of BirthD D M M Y Y Y YGender Male Female2. Contact DetailsHome PhoneHome EmailWere you born in Australia? Yes NoMobileIf no, in which country were you born?Work PhoneWork EmailHome Address (If you are an overseas student you need to supply your overseas address in this section)City / Suburb State Country PostcodeMail Address (Please state "as above" if same)City / Suburb State Country Postcode3. Cultural Diversity and CitizenshipDo you identify yourself in any of the following ethnic groups? (Tick all that apply)Aboriginal Torres Strait Islander South Sea Islander None of theseSelect one of the following to identify your citizenship statusAustralian CitizenNew Zealand CitizenAustralian Permanent ResidentStudent Visa4. EmploymentTemporary Resident VisaVisitor’s VisaBusiness VisaHoliday VisaEmployed full time by someone elseEmployed part time or casual by someone else or school based apprenticeSelf employed - not employing other peopleEmployer - someone who employs other people1234Other Visa (please specify)If entry to Australia on visa, what is your country of citizenship?Employment Status – Of the following categories, which best describes your current employment status? (Tick ONE box only)Employer DetailsCompany NameAddressEmployed unpaid family workerUnemployed - looking for full time workUnemployed - looking for part time workNot employed - not looking for employmentcompany Contactcity / SuburbState Postcode Phone Fax56785. LanguageDo you speak other language/s at home other than ENGLISH? No (Go to Question 6)Yes Please specify the main language spoken at home?Where English is NOT the main language spoken at home, please confirm how well you speak English. (Tick the relevant box below)Very Well Well Not Well Not at allIs English language assistance required? No Yes (If assistance is required contact the institute to discuss your needs)ISAS 351 Ver 1 (07/2013)

6. SchoolingWhat is your highest completed school level?Year 12 Year 11 Year 10 Year 9 or equivalent Year 8 or lower Did not go to schoolIn which year did you complete that school level? Y Y Y Y Are you still attending secondary school? No YesIf yes, provide grade and name of school –Grade7. Previous Qualifications Achieved (Please read carefully)Have you successfully completed any of the following qualifications?Bachelor Degree or Higher DegreeAdvanced Diploma or Associate DegreeDiploma or Associate DiplomaCertificate IV or Advanced CertificateCertificate III or Trade CertificateCertificate IIName of schoolNo Yes (If yes, tick all that apply)Certificate ICertificates other than aboveTraining Subsidy Eligibility (IMPORTANT - Please read carefully)For eligible Queenslanders, the Queensland Government will provide subsidised training for one certificate III qualification. As part of the terms and conditions of your enrolment into this program of study you arerequired to declare you are not the holder of a Certificate III or higher qualification gained outside of school. False or misleading information concerning your prior qualifications may result in you being withdrawnor being liable for further financial outlay or repayment of the fees for this program.Please note: Once you have completed this program you are no longer eligible to enrol in any Certificate III Government subsidised programs. It is a requirement at the completion of your studies that you submita Training and Employment Survey.8. DisclosureEducational authorities such as TAFE Queensland, research organisations contracted by TAFE Queensland, and the National Centre for Vocational Education Research conductsurveys of past and existing students for customer satisfaction, improvement and marketing purposes. If you have any objections to being contacted, please tick here.9. Disabilities (Answering these questions will not affect your enrolment)Do you consider yourself to have a disability, impairment or long term condition? Yes No (Go to Question 10)If yes, please indicate the areas of disability, impairment or long term condition:Hearing/DeafMental IllnessOther (please specify)PhysicalAcquired Brain ImpairmentIntellectualVisionWould you like to receive advice on support services,LearningMedical Conditionequipment and facilities which may assist (if available)?10. Emergency Contact (Person you want us to contact in an emergency)YesNoNameRelationship to student (e.g. Parent, Friend etc)PhonePrivacy StatementTAFE Queensland is collecting the information on this form to use and disclose for the following purposes:• To process and manage your enrolment, attendance, and progress of your training;• To report completion of assessment items to relevant external agencies and parties;• To undertake administrative tasks essential to the functioning of your TAFE Queensland institute; and• To manage future enrolments at TAFE Queensland institutes.As a matter of routine your personal information (including attendance details, progress, and results) will be disclosed to the following people, agencies, and organisations:• If you are a school based apprentice or trainee or VET in Schools student – Your school, the Queensland Studies Authority, and the Queensland Tertiary Admissions Centre (for your results only).• If you are enrolled in training paid for by your employer, or in which you consent to release information to your employer – Your employer.• If you are an apprentice or trainee – Your employer/host employer.• If you are under the age of 18 – Your parent/guardian (unless you have advised the institute that you are estranged from them, you are classified as independent, or it is otherwise inappropriate to give them theinformation).• All students – National Centre for Vocational Education Research and the Department of Industry, Innovation, Climate Change, Science, Research and Tertiary Education in accordance with the National VocationalEducation and Training Regulator Act 2011 and associated legislative instruments, and the Queensland Studies Authority in accordance with the Education (Queensland Studies Authority) Act 2002.Personal information collected on this form may also be disclosed to third parties with your consent or as permitted or required under a law. Your information will be stored securely. If you wish to access orcorrect any of your information, discuss how it has been managed, or have a concern or complaint about the way your personal information has been collected, used, stored, or disclosed, please contact your TAFEQueensland institute.For those students who require assistance in reading and understanding this Privacy Statement, the institute’s client services or student services staff and your teacher will be available to assist in explaining eachsection at the commencement of your training.Student Declaration (Please read carefully)• I agree to abide by the TAFE Queensland Rules and Regulations and Institute Policy (available from the institute) and acknowledge that facilities madeavailable for my use will be used only in accordance with the principles of proper use and relevant rules.• I confirm the accuracy of the information provided.• I understand I must provide evidence of concession eligibility at the time of enrolment. Subsequent evidence will not be accepted.• I confirm I have read and understood the Entitlement Eligibility statement listed under section 7.If under the age of 18 years, this form must be signed by a parent/guardian to complete this enrolment. This includes consent for the student to have access to the Internet throughTAFE Queensland.Parent/Guardian's signatureStudent's signature:(if student is under 18 years)Date:Date:Issues may arise beyond the institute’s control which affect its ability to deliver programs. Whilst every effort will be made to conduct all programs as advertised, the institute reserves the right to change orotherwise revise any program related issues including programs offered, class timetables, class locations and teacher allocations. The institute will make every reasonable attempt to advise students of any changesmade to their selected program. The details in this document are correct at the time of printing.ISAS 351 Ver 1 (07/2013)