LEARNER APPLICATION/ENROLMENT FORM
Sections marked with * must be completed. Completion of these sections is a regulation requirement.
Please write the name that you used when you applied for your Unique Student Identifier (USI), including any middle names
PERSONAL DETAILS(Please print)
Date of Birth:
Unique Student Identifier (USI)
Please enter your ten (10) character USI - Providing an invalid USI will result in your application being rejected or delayed*
What is USI?
Exempt from USI (evidence required to demonstrate eligibility for exemption):
*Address of Usual Residence:
Street or lot number:
Suburb, locality or town:
Postal Address: (if different from usual residence address)
Postal delivery information:
Suburb, locality or town:
Emergency contact person:
Emergency contact phone number(s):
LANGUAGE & CULTURAL DIVERSITY
Are you an aboriginal or torres strait islander?
Torres Strait Islander
In which country were you born?:
Antigua and Barbuda
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
British Indian Ocean Territory
Central African Republic
Cocos (Keeling) Islands
Congo, The Democratic Republic of the
Falkland Islands (Malvinas)
French Southern Territories
Heard Island and McDonald Islands
Holy See (Vatican City State)
Iran, Islamic Republic of
Isle of Man
Korea, Democratic People's Republic of
Korea, Republic of
Lao People's Democratic Republic
Macedonia, Republic of
Micronesia, Federated States of
Moldova, Republic of
Northern Mariana Islands
Palestine, State of
Papua New Guinea
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Sint Maarten (Dutch part)
South Georgia and the South Sandwich Islands
Svalbard and Jan Mayen
Syrian Arab Republic
Tanzania, United Republic of
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
United States Minor Outlying Islands
Venezuela, Bolivarian Republic of
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
An Australian citizen
A permanent resident of Australia
Holder of temporary protection visa
Holder of Temporary Residence Visa
Do you have any identification for concession
Pensioner Concession Card
Health Care Card
Commonwealth Seniors Health Crad
About ConcessionCard and Concession Fee:
Do you speak a language other than English at home?:
How well do you speak english:
Not at all
Do you have a disability or impairment?
If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list: (you may indicate more than one area)
Acquired brain impairment
What is your highest COMPLETED school level?
Year 8 or blow
Never attended school
In which YEAR did you complete that school level
Are you currently at school?
Have you completed any other qualifications in Australia?
please tick any applicable boxes
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)
Certificates other than above
Full time employee
Part time employee
Self-employer - not employing others
Employed - unpaid worker in a family business
Unemployed - seeking full - time work
Unemployed - seeking part-time work
Not employed - not seeking employment
To get a job
To develop my existing business
To start my own business
To try for a different career
To get a better job or promotion
It is a requirement of my job
I wanted extra skills for my job
To get into another course of study
For personal interest or self-development
Language Literacy and Numeracy (LLN)
Nova College s committed to support all of its students in successfully completing their selected qualification/s or short courses. For Nova College to best accommodate this, we ask that every learner select one of the following (if neither box is ticked, default is assumed no LLN support is needed) :
I appreciate that Nova College is interested in my LLN standards; however, I affirm that I do not require any assistance with LLN for the course I am choosing to undertake
I am unsure if my LLN standard is sufficient for the level of study I am undertaking. And I elect to complete the LLN assessment to help with assessing my LLN level.
*If you’ve selected this option, a Nova College staff member will contact you to arrange this assessment. The assessment will take about half hour.
BSB30120-- Certificate III in Business
CHC30113- Certificate III in Early Childhood Education and Care
CHC50113- Diploma of Early Childhood Education and Care
Provide an emergency first aid response in an education and care setting
Provide an CPR(pROVIDE cARDIO pULMONARY resuscitation）
I grant consent to Nova College to use, record and disclose my: name, image, recording and copyright material, including their written, artistic or musical works or video or sound recordings (Individual work).
Which days avaliable to attend class?
eight mile plains
1. I declare that the information I have provided is true and correct. I am aware of the consequences that may arise from providing false, misleading or incomplete information, including the cancellation of my enrolment or the withdrawal of any offer made by Nova College.
2. I understand that my RTO (Nova College) is required to submit data sourced from this enrolment form to the national VET administrative collection as a regulatory reporting requirement. The information contained on my enrolment form may be used by my RTO or the following third parties for administrative, regulatory and/or research purpose:
a. School – if I am a school based apprentice or trainee or VET in Schools student.
b. Employer – if I am enrolled in training paid by my employer.
c. Government departments and agencies and authorised VET related bodies.
d. VET regulators.
3. I agree that it is my responsibility to update my personal details with Nova College, should they change, in order to receive updated course information or Certificate/Statement of Attainment.
4. I recognise that it is my responsibility to provide all necessary documentary evidence of my qualifications and studies and hereby authorise Nova College to obtain further information where necessary.
5. I agree to abide by the rules and regulations of the training facility and am aware of the Student Manual of Nova College. I have accessed the Student Manual and have read and understood the learner policies in it.
6. I agree that the assessment material will become Nova College’s property once submitted. I agree I am responsible to make a copy for my own record (if desired), before submitting this material.
7. Sometimes Nova College promotes training activities through marketing or course materials. I agree that Nova College may use my image, quotes I have provided or comments I have made in Nova College promotional material and activities. I understand that I will not receive a separate notice or request for approval if/when this happens.
8. I agree that, where my employer has paid all or part of my course fee expenses, I authorise Nova College to issue a copy of my qualification Certificate or Statement of Attainment to my employer. I understand that Nova College will post the original Certificate or Statement of Attainment to me directly, to the address I provided on this form.
9. I understand that Nova College complies with the Privacy Act 1988, and that information collected on learners is only used for the purpose of delivery of service and as required by law, or for compliance with RTO registration requirements.
10. I have read and understood the pre-enrolment information and Student Handbook.
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