Notification of Enrolment Policy and Procedure
Consent to Use and Disclose Personal Information
CONSENT TO USE AND DISCLOSURE OF PERSONAL INFORMATION TO THE DEPARTMENT OF EDUCATION & COMMUNITIES AND OTHER GOVERNMENT AGENCIES
LEARNER INFORMATION
Title | |
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 | |
Country of Birth | If not Australia: |
City of Birth | |
Native Language | If not English: |
Aboriginal or Torres Strait Islander origin | |
Proficiency in Spoken English | |
English assistance needed | |
Qualification Name and Code | |
Qualification Start Date | |
Highest COMPLETED school level | |
Year Completed | |
Disabilities | |
Dependent child or partner of a person in receipt of a disability support pensions | |
Unique Student Identifier(USI) | |
| |
Australian Citizenship | |
Permanent resident or Humanitarian Visa holder | |
I am registered as a NSW apprentice or new entrant trainee | |
Last Qualification completed since leaving school | |
Currently enrolled in a Qualification Course(s) other than the one this form applies to. |
If Yes, name of course(s): |
Do you wish to apply for Recognition of Prior Learning? | |
Do you have any special needs? | |
Do you require support with any of the following | |
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)
|
|
Today’s Date | |
EMERGENCY CONTACT DETAILS | |
Emergency Contact Name | |
Relationship with Contact | |
Emergency Contact’s Phone Number | |
English Proficiency of Emergency Contact | |
Other languages spoken by your Emergency Contact Person, if English is not spoken |