Booking and Enrolment Form

COURSE & QUALIFICATION CODE*
—Please choose an option—52887WA Certificate II In PlumbingAUR20720 Certificate II In Automotive Vocational PreparationCPC10120 Certificate I In ConstructionUEE22020 Certificate II In Electrotechnology (Career Start)

COMMENCING*
—Please choose an option—Term 1Term 2Term 3Term 4

 FOR THE YEAR 2024 COURSES

PREFERRED TRAINING DAY*(Please complete all 4 preferences)

PERSONAL DETAILS

Title*
MrMrsMsMissOther

Family Name*

First Name*

Middle Name
I do not have a middle name (please tick)

Previous Name/s
I do not have a previous name (please tick)

Date of Birth*

Gender*
MaleFemaleOther

CONTACT DETAILS

Mobile Phone*

Home Phone

Work Phone

Student's School Email*

Student's Personal Email*

Parent's Email*

ADDRESS

Home Address*

Postal AddressSame as Home AddressNot the same

CULTURAL DIVERSITY & CITIZENSHIP

Are you of Aboriginal or Torres Strait Islander origin?*(Tick all that apply)
AboriginalTorres Strait IslanderNone of these

Where you born in Australia?*
YesNo

City of birth*

What is your citizenship status?*Please select one of the below
Australian CitizenTemporary Resident VisaNew Zealand CitizenAustralia Permanent ResidentStudent VisaVisitor’s VisaOther

EMPLOYMENT

What is your current employment status?*Please select one of the below

LANGUAGE

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

SCHOOLING

Are you currently attending school?*
YesNo

What is your LUI (Learning Unique Identifier)?

DISABILITY

Do you consider yourself having a disability, impairment or long term condition?*
YesNo

PREVIOUS QUALIFICATIONS ACHIEVED

Have you successfully completed any of the following qualifications?*
YesNo

Have you completed any units of competency that may be applied as credits towards this qualification?
YesNo

STUDY REASON

What is your main reason for enrolling in this program?
Studying as part of school program

UNIQUE STUDENT IDENTIFIER

From 1 January 2015, PPS College/Gold Coast Trades Collegeare unable to issue 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). If you have notyet obtained a USI you can apply for it directly at http://www.usi.gov.au/create-your-USI/ Please note that if you would like to specify your gender as ‘other’ you will need to contact the USI Office for assistance.

Enter your Unique Student Identifier (USI) (if you already have one)

EMERGENCY CONTACT

Contact Name*

Contact Phone Number*

Relationship*

PERMISSION TO PUBLISH YOUR WORK OR IMAGES

(Please refer to the Student Handbook for more information on what may be done with videos and images.)

Do you give permission for video or photographic images of you/your work to be taken and published?*
YesNo

HOW DID YOU HEAR ABOUT US?*

PPS StaffPPS WebsiteFriendFamilySchoolCareer ExpoJob AgencyApprenticeship CentrePrint/AdvertFacebookInstagramGoogle+LinkedInCold CallOther

Please rate yourself on a scale of 1-5 in the following areas (1 is low and 5 is high)

My ability to organise my time and resources*

12345

My ability to read English*

12345

My ability to write English*

12345

My ability to speak English*

12345

My numeracy/mathematics skills*

12345

Do you need assistance because of language, literacy or numeracy issues?*

YesNo

PLEASE READ CAREFULLY AND SIGN THE PRIVACY STATEMENT AND STUDENT DECLARATION

Privacy Notice
Under the Data Provision Requirements 2012, PPS College/Gold Coast Trades College(PPS/GCTC)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 and your training activity data) may be used or disclosed by PPS/GCTC for statistical, administrative, regulatory and research purposes. PPS/GCTC may disclose your personal information for these purposes to third parties, including:

• School –if you are a secondary student undertaking VET, including a school-based apprenticeship or traineeship;

• Employer –if you are enrolled in training paid by your employer;

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

• NCVER;

• Organisations conducting student surveys; and

• Researchers.

Personal information disclosed to NCVER may be used or disclosed 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).

Student Declaration and Consent

• I declare that the information I have provided to the best of my knowledge is true and correct.

• I consent to the collection, use and disclosure of my personal information in accordance with the Privacy Notice above.

• I have received a copy of the PPS/GCTC Student Handbook. I acknowledge it is my responsibility to read, understand and follow the terms and conditions it sets out. I understand this does not cancel my rights as applicable according to state and/or federal law.

• By signing this document, I give permission for PPS/GCTC to access my Unique Student Identifier for the purpose of my training and if I do not have a USI, I authorise PPS/GCTC to apply, pursuant to sub-section 9(2) of the Student Identifiers Act 2014, for a USI on my behalf

SHIRT ALLOCATION

As part of the program all students receive a free Hi-Vis shirt. Please see the style guide below to help you select your size.

SELECT YOUR SIZE*
—Please choose an option—SMLXL2XL3XL5XL

While Gold Coast Trades College provides a free Hi-Vis shirt, students will need to provide their own steel cap boots and work shorts.

Student Signature*
Please put your signature in the space below.

DATE*

Parent Signature
Please put your signature in the space below.

DATE

Upload your ID*
Australian IDDriver's LicensePassport