W TRAIN LMS

CONSENT TO USE AND DISCLOSURE OF PERSONAL INFORMATION TO THE DEPARTMENT OF EDUCATION & COMMUNITIES AND OTHER GOVERNMENT AGENCIES

(First, Middle, and Last Name)

(Current residential address)

With date of birth:

Please add a current and valid photo ID in this upload box. E.g. NSW Drivers License or passport.

Understand and agree that personal information (information or an opinion about me), collected from me, my parent or guardian, such as my name, Unique Learner Identifier, date of birth, contact details, training outcomes and performance, or sensitive personal information (including my ethnicity or health information) (together Personal Information) collected by AD1 College, may be disclosed to the Department of Education & Communities (Department).

The Department may disclose my personal information to other Australian government agencies, including those located in States and Territories outside of New South Wales.

The above government agencies may use my Personal Information for any purpose relating to the exercise of their government functions, including but not limited to the evaluation and assessment of my training, the determination of my eligibility to receive subsided training or for any Fee Exemption or Concessions. My Personal Information may also be disclosed to other third parties if required by law.

I consent to the collection, use and disclosure of my Personal Information in the manner outlined above.

I also acknowledge and agree that the Department may contact me by telephone, email or post during or after I have ceased subsidised training with the College of Transformation, Education and Training for the purposes of evaluating and assessing my subsided training.

I confirm that I have been understood the contents of the Learner Handbook.

Today’s Date:

NOTE: IF UNDER 18 YEARS OF AGE AT THE TIME OF GIVING CONSENT, THEN THE CONSENT OF THEIR GUARDIAN IS REQUIRED

Full Name of Guardian:

Signature of Guardian

I declare I am the person whose name is written here and I give consent for this training.

Date

Prospective Learner Declaration

I,	(First, Middle, and Last Name)
Of	(Current residential address)
With date of birth:
Declare that all information provided by myself to AD1 College in connection with the Notification of Enrolment Process is true, accurate, complete and not misleading in any way. I have been informed of (delete as relevant) There is not a subcontracting arrangement in place The fees chargeable The Learner Information as follows: Recognition of Prior Learning and Credit Transfer Consumer protection information Subcontractor information if relevant What a learner should do if they wish to defer or discontinue training How learners can access support during training Contact details for any support services provided Learner Handbook
Today’s Date
EMERGENCY CONTACT DETAILS
Emergency Contact Name
Relationship with Contact
Emergency Contact’s Phone Number
English Proficiency of Emergency Contact	Very well Well Not well Not at all
Other languages spoken by your Emergency Contact Person, if English is not spoken

Title	Mr Mrs Miss Ms Other
Given Name(s)
Middle Name
Surname
Preferred name if different
Date of birth
Mobile phone number
Home phone number	(02)
Home Email
Work Email
Address
Post Code
Gender	Male Female Other
Country of Birth	If not Australia:
City of Birth
Native Language	If not English:
Aboriginal or Torres Strait Islander origin	Yes No
Proficiency in Spoken English	Very well Well Not well Not at all
English assistance needed	Yes No If yes, you will be directed towards a Learning Centre. Please contact AD1 College Administration on (02) 9594 0655.
Qualification Name and Code
Qualification Start Date
Highest COMPLETED school level	Year 12 or equivalent Year 11 or equivalent Year 10 or equivalent Year 9 or equivalent Year 8 or equivalent Never attended school
Year Completed
Disabilities	Yes No
Dependent child or partner of a person in receipt of a disability support pensions	Yes No
Unique Student Identifier(USI)
I have not supplied my USI. I would like AD1 College to apply for one on my behalf and I have signed the Privacy Form.
Australian Citizenship
Permanent resident or Humanitarian Visa holder	A Certificate of Evidence of Residence Status (CERS) Humanitarian visa
I am registered as a NSW apprentice or new entrant trainee	Yes No
Last Qualification completed since leaving school
Currently enrolled in a Qualification Course(s) other than the one this form applies to.	Yes No If Yes, name of course(s):
Do you wish to apply for Recognition of Prior Learning?	Yes No
Do you have any special needs?	Yes No
Do you require support with any of the following	Speaking Difficulties Listening Difficulties Reading Difficulties Writing Difficulties
	Flexibility with delivery due to work, family, or other commitments

Notification of Enrolment Policy and Procedure

Consent to Use and Disclose Personal Information

LEARNER INFORMATION

Prospective Learner Declaration

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Notification of Enrolment Policy and Procedure

Consent to Use and Disclose Personal Information

LEARNER INFORMATION

Prospective Learner Declaration