0402 076 859
The information contained in this form is used for enrolment and statistical purposes to assist in research and evaluation by relevant government agencies and Dermal Therapy Courses.
Course Name (required)
Delivery mode *DistanceFace to FaceCombination
Is RPL being sought as part of this qualification? If yes, please contact your trainer for further detailsYesNo
Course Commencement Date
First Name *
Street Address *
Date of Birth
Unique Student Identifier (USI)
Are You*AboriginalTorres Straight IslanderAboriginal Torres Straight IslanderNone
Where you born in Australia?*YesNo
If no, in which country you born?
Is English your first spoken language ? *YesNo
Do you speak a language other than English at home?YesNo
If yes, what other language do you speak?
How well do you speak English? *WellNot wellNot at all
Do you have a disability, impairment or long term health condition?YesNo
If yes, please advise condition.
Do you or your partner/dependant hold a health or pensioner care card with your name on it? *YesNo
If yes, please upload a copy of your card.
Relationship to you *
Mobile phone *
Are you currently attending high school? *YesNo
If yes, what year are you in?
What is your highest completed school level? *Year 9Year 10Year 11Year 12
Have you successfully completed any of the following qualification levels? Please select all that apply.Certificate ICertificate IIICertificate IVDiplomaAdvanced DiplomaBachelor Degree or higherNone
Name of highest qualification?
Have you started but not completed any qualifications?YesNo
If yes, please specifyPlease select all that apply.Certificate ICertificate IICertificate IIICertificate IVDiplomaAdvanced Diploma of Association DegreeBachelor Degree or Higher Degree levelMiscellaneous
Name of Qualification
Of the following, which best describes your current employment status ? *EmployerFull time employeePart time employeeUnemployed - seeking full time workUnemployed - seeking part time workSelf employed but not employing others
If working, how many hours per week do you work?
Date employment commenced with Employer
What is your main reason for undertaking this course?To get employmentTo change careersJob requirementTo develop existing skillsTo get a better jobPersonal interestTo start my own businessTo get a promotionTo get into another course of study
Business Trading Name
Workplace Supervisor Name
How did you hear about us? Please select all that apply.FacebookGoogle SearchWord of MouthOther
Declaration *I confirm the accuracy of the information providedI have received and read the Student Information HandbookI have read, understood, and agree to the Refund PolicyI consent to the disclosure of my details by the RTO to government agencies as required under the Training and Employment ActIf doing a post school certificate III qualification under the Queensland Certificate III Guarantee Scheme, I understand I extinguish my entitlement to a subsidised training place once it has been successfully completed
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By submitting this form, I agree to the information entered being used strictly within the framework of my request. *
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