Qualification and Course

This form is to enroll into -

ACM10121 Certificate I Animal Care Industry Pathways

Personal Details

Title *

First Name *

Last Name (surname) *

Any Previous/Maiden Names

Date of birth *

Gender *

Email *

Alternate Email Address (optional):

Address

Street Address *

City *

State *

Postal code *

Postal Address (if different from above):

Mobile Phone *

Unique Student Identifier (USI)

From 1 January 2015, Pet Stylist Academy can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your course if you do not have a Unique Student Identifier (USI). In addition, we are required to include your USI in the data we submit to NCVER.

To create a USI number or to retrieve an existing USI number, go to the following Government website: https://www.usi.gov.au/students

USI (must be TEN characters - numbers and letters combination) *

Citizenship, Cultural Diversity and Language

Where you born in Australia? *

Yes

If NO, provide country of birth:

Citizenship Status *

Are you of Aboriginal or Torres Strait Islander origin? *

Yes

If YES, provide origin:

Do you speak a language other than English at home? *

Yes

No, English ONLY

If YES, what language do you speak?

How well do you speak and understand English? *

Disabilities and Assistance

Do you have a disability, impairment or long term medical condition which may affect your studies? *

If YES, please indicate the area of disability, impairment or long term medical condition

If 'Other' please specify:

Do you require special assistance with the following (please tick if assistance is required):

Education Details

Are you currently studying a Certificate III or higher qualification? *

Yes

Are you currently enrolled in secondary or senior secondary education? *

Yes

What is your highest COMPLETED school level? *

Please tick all boxes for any nationally recognised qualifications you have SUCCESSFULLY completed since leaving school: *

From the following categories, select the one that BEST describes the main reason you are undertaking this qualification or course *

Employment Status

Which of the following best describes your current employment: *

If employed, please provide the business name:

How long have you been employed with this employer?

Please provide your supervisors name and contact phone number:

Identification Documents (ID)

We require Identification Documents to support your enrollment. All documentation must be submitted to the Pet Stylist Academy prior to a student commencing their qualification or course. All ID is kept securely in your student file.

ID email copies to - [email protected]

Identification Documents provided

Privacy Notice

Under the Data Provision Requirements 2012, Pet Stylist Academy is required to collect personal information about you and to disclose that personal information to the National Centre for Vocational Education Research Ltd (NCVER).

Your personal information (including the personal information contained on this enrolment form), may be used or disclosed by Pet Stylist Academy for statistical, administrative, regulatory and research purposes. Pet Stylist Academy may disclose your personal information for these purposes to:

• Commonwealth and State or Territory government departments and authorised agencies; and

• NCVER.

Personal information that has been disclosed to NCVER may be used or disclosed by NCVER for the following purposes:

• populating authenticated VET transcripts.

• facilitating statistics and research relating to education, including surveys and data linkage.

• pre-populating RTO student enrolment forms.

• understanding how the VET market operates, for policy, workforce planning and consumer information; and

• administering VET, including program administration, regulation, monitoring and evaluation.

You may receive a student survey which may be administered by a government department or NCVER employee, agent or third party contractor or other authorised agencies. Please note you may opt out of the survey at the time of being contacted. NCVER will collect, hold, use and disclose your personal information in accordance with the Privacy Act 1988 (Cth), the National VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au).

For more information about NCVER's Privacy Policy go to https://www.ncver.edu.au/privacy.

Student Declaration

1. I am applying to enroll in a course with Pet Stylist Academy. I agree that I have read and understood and agree to be bound by the conditions as described in the Student Handbook.

2. I understand that failure to comply with obligations as laid out in the Student Handbook could lead to suspension or cancellation of my enrollment.

3. I acknowledge that it is my responsibility to pay all fees as agreed and that my Certificate or Statement of Attainment will not be processed until all fees are paid in full.

4. I have read and understood the Pet Stylist Academy Refund and NCVER privacy policies as stated in the Student Handbook.

5. I am not currently enrolled in a post school qualification.

6. I agree that the information I have provided is, to the best of my knowledge, true and correct.

Date of Declaration *

Student Signature *

Clear