Online Enrolment Form

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· A must: Please view student handbook in the conjunction with this enrolment form for complete policies and procedures.

Click To Download Student Handbook

I have Read the Student Handbook. YOU CAN NOT CONTINUE TILL YOU HAVE ACCESSED THE STUDENT HANDBOOK. *

Section 1 – Personal Details

Personal Details Title: *

Mr
Mrs
Ms
Miss
Other

Personal Details Name: *

First

Last

Date of Birth *

Date

Time

Country of Birth *

Personal Details Gender: *

Male
Female
Other

Section 2 – Contact Details

Personal Contacts

Contact Details Phone: (Home) *

Contact Details Mobile:

Contact Details Email: *

Home Address:

Contact Details Address: *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Mailing Address: (Leave if as above)

Next of Kin:

Next of Kin: Name *

First

Last

Next of Kin: Relationship: *

Next of Kin: Phone *

Section 3 – Workplace Details (if applicable)

Click Next if not applicable

Workplace Details Company Name:

Workplace Details Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Workplace Details Contact Person:

Workplace Details Work Phone No:

Section 4 – Qualification / Course Details

Qualification / Course Details Course *

Qualification / Course Details Study Mode *

Online

Qualification / Course Details Unique Student Identifier (USI) *

https://www.usi.gov.au/faqs/find-your-usi If you have never had a USI go to: https://www.usi.gov.au/your-usi/create-u

Click To Get Your USI

Section 5 - ID

Identification Type and Number (must have photo) *

Upload front and back of your Photo Id *

Click or drag files to this area to upload. You can upload up to 4 files.

Section 6 - Personal information

Which of the following statements best describes your reason for enrolling in this course?

Personal information *

Personal Interest
To get a job
To get a better job or promotion
I want extra skills for my job
Requirement of my job
To start my own business
To develop my existing business
To try another career
Meet CPD / license / vocational requirements
To gain a qualification

Personal information: Other if above is not covered

Section 6b Language and Literacy

(Please choose by placing an X in the boxes that apply to you)

Language and Literacy: Are you an Australian Citizen? *

Language and Literacy: If NO, what is your country of birth?

Language and Literacy: If NO, Please State your Visa Classification (if applicable) – eg 572, 457 etc

Language and Literacy: Is English your First Language? *

Language and Literacy: If NO, what language do you usually speak?

Language and Literacy: If NO, How well do you speak English?

Very Well
Well
Minimal
Not at all

Section 7 - Indigenous Status

(Please choose by placing an X in the boxes that apply to you)

Indigenous Status: Please Choose *

Yes, Aboriginal
Yes. Torres Strait Islander
Yes, Aboriginal and Torres Strait Islander
No, Neither Aboriginal or Torres Strait Islander

Section 8 -Education

What is your highest level of education COMPLETED?

Education *

Did not go to school
Year 8 or Below
Completed Year 9 or Equivalent
Completed Year 10 or Equivalent
Completed Year 11 or Equivalent
Completed Year 12 or Equivalent

Education: Year you completed Shcool *

Education: Name of School *

Section 9 Employment Status

Training (Please choose by placing an X in the boxes that apply to you)

Employment Status *

Full-Time Employee
Part-Time Employee
Self-Employed (Not Employing Others)
Employer
Employed – Unpaid Worker in Family Business
Unemployed – Seeking Full-Time Work
Unemployed – Seeking Part-Time Work
Not Employed – Not Seeking Employment

Section 10 Training

(Please choose by placing an X in the boxes that apply to you)

Training: Have you completed any other courses / qualifications? (Specify Below) *

Training: If YES please select

Certificate I
Certificate II
Certificate III
Certificate IV
Diploma/Adv Diploma
Bachelor
Post Grad
Masters/Doctorate
Other

Section 11 Disability Status

Do you consider that you have a disability, impairment / long term condition that may affect your participation in the course?

(Please choose by placing an X in the boxes that apply to you)

Disability Status: Do you consider that you have a disability, impairment / long term condition that may affect your participation in the course? *

Disability Status: If you answered NO, then answer the following

Hearing / Deafness
Physical
Intellectual
Learning
Mental Illness
Acquired Brain Impairment
Vision
Medical Condition
Other

Disability Status: Do you need any additional support?. If you indicated the presence of a disability, impairment or long-term condition, would you like to receive information on support services which may assist you? *

Disability Status: If YES, Specify support required :

Section 12: I am applying for RPL/RCC for the following course: Are you seeking credit for previous training or recognition of prior learning?

RPL/RCC: Do you have Credit Transfers or Recognition of prior Learning *

Section 13: Payment

Please indicate how you intend on paying for your qualification/course. * Eligibility requirements apply

Payment Type *

I will be a full fee-paying student
Smart and Skilled (NSW Only )*
Other

Section 14: Acceptance Declaration

Acknowledgement

Acceptance Declaration: Did you complete this form yourself? If not, who completed this for you?

Acceptance Declaration: Course cost $

Acceptance Declaration: Deposit to be paid $

Acceptance Declaration: Frequency of Payment is: Tick

Weekly
Fortnight
Monthly

Acceptance Declaration: Frequency of payment amount: $

Acceptance Declaration: How many payments in total: $

Declaration

· I have been inducted into the processes of MMISS and I have read and understand my requirements within the client handbook in regards to adherence to all policies and procedures. I confirm that MMISS has provided the information set out above. (If you have not been issued the Handbook email MMISS at support@mmiss.org for a copy.) · I hereby agree to the payment terms and plan as outlined.

Acceptance Declaration: Name *

First

Last

Acceptance Declaration: I agree to this enrollment *

Acceptance Declaration: Date / Time

Date

Time