The Imperial College of Australia A.B.N. 85 123 406 039 212 Hoddle St, Abbotsford Victoria 3067, Australia Postal Address: PO Box 375, Abbotsford Victoria 3067, Australia Tel 61 3 9417 4777, Fax 61 3 9417 4787 Web www.imperial.edu.au Email
[email protected]
Application for Enrolment – VET FEE-HELP Please tick the course(s) you wish to enrol in Faculty of Information and Communications Technology ICT50415 Diploma of Information Technology Networking
ICT60215 Advanced Diploma of Network Security
Faculty of Telecommunication Engineering ICT50210 Diploma of Telecommunications Network Engineering
ICT60210 Advanced Diploma of Telecommunications Network Engineering
ICT80415 Graduate Diploma of Telecommunications Network Engineering Faculty of Business and Management BSB50215 Diploma of Business
BSB51915 Diploma of Leadership and Management
BSB61015 Advanced Diploma of Leadership and Management Faculty of Marketing BSB51215 Diploma of Marketing
BSB60515 Advanced Diploma of Marketing
Faculty of Hospitality Management SIT50313 Diploma of Hospitality
SIT60313 Advanced Diploma of Hospitality
Preferred Course Start Date: ________/_________/_________
On Campus
Online/ Distance
Personal Details Given Name:
Surname:
(Legal Given name)
(Legal Family name)
Date of Birth:
/
/
Gender: Male Female
Town of Birth:
Country of Birth:
Phone (home):
Mobile:
Email Address: Usual Residence
Postal Address, (if different to usual residence)
Building/ Property Name:............................................
Building/ Property Name:............................................
Flat/Unit Number:........................ Street No:.............
Flat/Unit Number:........................ Street No:.............
Street Name:..............................................................
Street Name:..............................................................
Suburb, Locality or Town:..........................................
PO box or roadside delivery box :.............................
State/Territory:........................Postcode:....................
Suburb, Locality or Town:.......................................... State/Territory:........................Postcode:....................
BJSB Pty Ltd trading as The Imperial College of Australia CRICOS ID: 02858M RTO ID: 121966
Application for Enrolment - VFH Version: September 2015 Page 1 of 5
The Imperial College of Australia Emergency Contact Details Name:
Phone Number
Address: Relationship to Applicant: Citizenship (tick one)
Holder of Permanent Resident Visa Holder of Special Category Visa (New Zealand
Australian Citizen Holder of a Temporary Protection Visa East Timorese asylum seeker
sub-class 444)
Language and Cultural Diversity In which country were you born?
Australia
Other- please specify:............................................
Do you speak a language other than English at home?
No
Yes Please specify:_____________________________ How well do you SPEAK English?
Very Well
Well
Not Well
Not at All
How well do you READ English?
Very Well
Well
Not Well
Not at All
How well do you WRITE English?
Very Well
Well
Not Well
Not at All
Are you of Aboriginal or Torres Strait Islander origin?
Yes, Aboriginal
No
Yes, Torres Strait Islander
Disability Do you consider yourself to have a disability, impairment or long-term condition?
No
Yes (If Yes, please specify the areas of disability, impairment or long-term condition. You may indicate more than one area. Please attach documentation describing your disability, impairment or long-term condition in more detail.) Hearing/Deaf
Intellectual
Mental Illness
Medical Condition
Physical
Learning
Vision
Acquired Brain Impairment
Others: Schooling Are you still attending Secondary School?
No
Yes
What is your Highest COMPLETED school level? (Tick ONE box only)
Completed Year 12 Completed Year 11 Completed Year 10 Completed Year 9 or Equivalent Completed Year 8 or Lower Did not go to High School
In which YEAR did you complete the above school level? ______________________ Name of school: ______________________________ Country / State:_______________________________
BJSB Pty Ltd trading as The Imperial College of Australia CRICOS ID: 02858M RTO ID: 121966
Application for Enrolment - VFH Version: September 2015 Page 2 of 5
The Imperial College of Australia Previous Qualification(s) (Tick the appropriate box, if you have completed any of the following qualifications in Australia or hold an overseas qualification which is assessed by relevant assessing authority in Australia as equivalent to Australian Qualification)
Bachelor Degree of Higher Degree Associate Degree Advanced Diploma
Diploma(or associate Diploma) Certificate IV (Adv Certificate /Technician)
Certificate III (or Trade Certificate)
Overseas qualification
Certificate II Certificate I Certificates other than the above None
Current Employment Details
Full-time employee Part-time employee Not employed – not seeking employment Employed- unpaid worker in a family business
Employer Self Employed - not employing others Unemployed – seeking part -time employment Unemployed – seeking Full -time employment
Study Reason
To get a job To develop my existing business To start my own business To try for a different career To get a better job or promotion
It was a requirement of my job I wanted extra skills for my job To get into another course of study For personal interests or self development Other reasons
Numeracy and Literacy Level, Credit Transfer and RPL Do you require any language, literacy or numeracy assistance?
YES
NO
Are you seeking Credit Transfer
YES
NO
Recognition of Prior Learning?
YES
NO
If YES, Application for Credit Transfer/Recognition of Prior Learning along with relevant supporting documents must accompany this application form. Victorian Student Number (VSN) Victorian Student Number (VSN) Have you attended any Victorian school since 2009 or done any training with a vocational education and training (VET) registered training organisation or an Adult and Community Education provider in Victoria since 2011? No- I have not attended a Victorian school since 2009 or a TAFE or other VET training provider since the beginning of 2011 Yes- I have attended a Victorian school since 2009. Please specify the most recent Victorian school attended: ........................................................... And / or Yes- I have participated in training at a TAFE or other training organisation since the beginning of 2011 List the most recent training organisations with which you have participated in training in Victoria since 2011 (List up to 3 training organisations) 1...............................................................................
2. ... ...........................................................................
3...............................................................................
Unique Identifier Number (USI) BJSB Pty Ltd trading as The Imperial College of Australia CRICOS ID: 02858M RTO ID: 121966
Application for Enrolment - VFH Version: September 2015 Page 3 of 5
The Imperial College of Australia All students studying nationally recognised training in Australia from 1 January 2015 will be required to have a Unique student Identifier (USI). A USI is an account (or reference number) made up of numbers and letters. The USI will allow students online access to their training records and results (transcript) through their online USI Account USI No: _________________________________________ (Please attach copy of proof of USI Number)
Education Agents Details If you were referred by an Education Agent, please provide details below Agent Name / Business Name: As an approved agent of Imperial, I am also certifying that I have verified all the original documents of the student.
Signature:____________________________________
Student Declaration BJSB Pty Ltd trading as The Imperial College of Australia is collecting the information on this Application form for the purpose of assessing student’s eligibility for the Higher Education Loan Program (HELP) under the Higher Education Support Act 2003. Students’ personal information will be collected by fair and lawful means which is necessary for the purpose of enrolment and function of Imperial and is committed to ensuring the confidentiality and security of the information provided. This policy is issued in accordance with the Higher Education Support Act 2003 (HESA) and the Privacy Act (2000). I understand that The Imperial College of Australia may refuse, vary, reverse or terminate my enrolment on the basis of untrue, misleading or incomplete information. I declare that all information provided in this application is complete and correct. I understand that failure to provide correct information or documentation in relation to this application may result in cancellation of my enrolment.
Signature of applicant
Signature of Parent or Legal Guardian (if applicant is under 18 years of age)
Date
Application Submission Submit completed Application to:
Admissions Officer The Imperial College of Australia
212 Hoddle St, Abbotsford, Victoria 3067, Australia Postal Address: PO Box 375, Abbotsford, Victoria 3067, Australia Telephone: 03 9417 4777 Fax: 03 9417 4787 Email:
[email protected] Attach following documents:
Evidence of date of birth Evidence of Australian Citizenship/Permanent Humanitarian Visa Evidence of USI Number Tax File Number
BJSB Pty Ltd trading as The Imperial College of Australia CRICOS ID: 02858M RTO ID: 121966
Application for Enrolment - VFH Version: September 2015 Page 4 of 5
The Imperial College of Australia Office Use Only Date Application Received: ____________________Received by: _______________________________ Decision on Application: Accepted / Rejected Staff Signature: Date:
BJSB Pty Ltd trading as The Imperial College of Australia CRICOS ID: 02858M RTO ID: 121966
Application for Enrolment - VFH Version: September 2015 Page 5 of 5