Last Name *

First Name *

Date of birth

Student ID

Preferred name

Name to use on your Participation certificate

Building/ Property Name

Flat/unit details

Street or lot number (eg 222 or Lot 18)

Street Name

Suburb, locality or town

State/Territory

Home Phone *

Work Phone *

Email *

Alternative email address (optional)

Gender

Have you studied with us previously?

In which country were you born?

Australia

others

other - please specify

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) Please refer to the Disability supplement page for an explanation of the following disabilities.

What is your highest COMPLETED school level? (Tick ONE box only) If you are currently enrolled in secondary education, the Highest school level completed refers to the highest school level you actually completed and not the level you are currently undertaking. For example, if you are currently in Year 10 the Highest school level completed is Year 9.

Are you still enrolled in secondary or senior secondary education?

Yes

No

Previous qualifications achieved. Have you SUCCESSFULLY completed any of the qualifications listed in question?

Yes

No

If YES, tick ALL applicable boxes.

Bachelor degree or higher degree

Advanced diploma or associate degree

Diploma (or associate diploma)

Certificate III (or trade certificate)

Certificate II

Certificate I

Other education (including certificates or overseas qualifications not listed above)

Employment Of the following categories, which BEST describes your current employment status? (Tick ONE box only) For casual, seasonal, contract and shift work, use the current number of hours worked per week to determine whether full time (35 hours or more per week) or part-time employed (less than 35 hours per week)

Full-time employee

Part-time employee

Self-employed: not employing others

Self-employed – employing others

Employed – unpaid worker in a family business

Unemployed – seeking full-time work

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 mail, telephone, email or post during or after I have ceased subsidised training with Coaching College for the purpose of evaluating and assessing my training. *

Agree

The Department may disclose my Personal Information to other Australia government agencies, including those located in States and Territories outside New South Wales. The above government agencies may use my Personal Information for any purpose relating to the exercises of their government functions, including but not limited to the evaluation and assessment of my training, the determination of my eligibility to receive subsidised training or for any Fee Exemptions or Concessions.

agree

I understand and agree that personal information (information or opinion about me), collected from me, my parent or guardian, such as my name, date of birth, contact details, training outcomes and performance, or sensitive personal information, including my ethnicity or health information (together Personal Information) collected by ACWE may only disclosed to government I also understand and agree that ACWE: collects this information is for your enrolment to be processed into the nominated course uses my personal information to enable us to deliver courses to you, and otherwise, as needed, to comply with our obligations. *

Agree

* I declare: That the information I have supplied on this form is true, correct and complete. I understand that the giving of forged, false or misleading information may lead to the cancellation of my enrolment. The Policies, Procedures and Student Information have been made available to me and I have read, understood and accepted these as conditions of my enrolment. I have been informed of fees and charges associated with this course, including the requirements and timelines to withdraw without incurring fees. I acknowledge that while I am enrolled I will comply with the rules, policies, procedures and by-laws of ACWE. *

Agree

Student name *

Date *