Enrolment Form

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Kangan Institute

• Leave blank if new KI student or unsure. Customer Service Officer will complete.

• KI Student ID Number?

Student Details

• Surname (legal Family Name)?

• Title?

  Mr

  Miss

  Mrs

  Ms

  Others

• Given Legal Name/s?

• Gender?

  Male

  Female

• Date of birth?

• Property Name (if applicable)?

• Number and street address

• Suburb?

• State?

  Select Queensland New South Wales Victoria Tasmania South Australia Northern Territory Western Australia Other

  • Queensland
  • New South Wales
  • Victoria
  • Tasmania
  • South Australia
  • Northern Territory
  • Western Australia
  • Other

• Post code?

• Country (if not Australia)?

• Daytime Phone Number?

• Work Phone Number?

• Mobile Phone Number?

• Email Address?

Emergency Contact Details

• Emergency Contact Name?

• Relationship to student?

• Daytime Phone Number?

• Mobile Phone Number?

Personal Details

• Do you speak English at home?

  Yes

  No

  N/A

• If you answered No, what is your usual language?

• We're you born in Australia?

  Yes

  No

  N/A

• If you answered No, in which country were you born?

• Are you of Aboriginal or Torres Strait Islander origin?

  No

  Yes-Aboriginal

  Yes-Torres Strait Islander

  Yes-Aboriginal AND Torres Strait Islander

• Do you have any disabilities, impairments or long term conditions?

  Yes

  No

  N/A

• If you answered Yes, which ones?

  Select Hearing Physical Intellectual Learning Mental Illness Acquired Brain Impairment Vision Medical Condition Other More Than One

  • Hearing
  • Physical
  • Intellectual
  • Learning
  • Mental Illness
  • Acquired Brain Impairment
  • Vision
  • Medical Condition
  • Other
  • More Than One

• Do you required advice or assistance support for any of these? For more information, please call 9279 2511.

  Yes

  No

  N/A

Disclaimer

• Note: Kangan Institute reserves the right to cease delivery in particular qualifications at any time. Where this occurs, students who have yet to complete, will be formally notified of alternative arrangements, including transfer to another qualification within Kangan Institute or to another RTO.

Education

• Indicate the main reason for studying this course.

  Select (01) To get a job (02) to develop my existing business 03) To start my own business (04) To try a different career (05) To get a better job or promotion (06) It was a requirement of my job (07) I wanted extra skills for my job (08) To get into another course or study (11) Other reasons (12) For personal interest or self development

  • (01) To get a job
  • (02) to develop my existing business
  • 03) To start my own business
  • (04) To try a different career
  • (05) To get a better job or promotion
  • (06) It was a requirement of my job
  • (07) I wanted extra skills for my job
  • (08) To get into another course or study
  • (11) Other reasons
  • (12) For personal interest or self development

• Have you successfully completed a qualification in the past?

  Yes

  No

  N/A

• If Yes, indicate which of the following qualifications you have SUCCESSFULLY COMPLETED (only indicate those that are recognized in Australia)

  Select Bachelor Degree or Higher Degree Advanced Diploma or Associate Degree Diploma or Associate Diploma Certificate IV or Advanced Certificate Certificate III Certificate II Certificate I Other Certificates

  • Bachelor Degree or Higher Degree
  • Advanced Diploma or Associate Degree
  • Diploma or Associate Diploma
  • Certificate IV or Advanced Certificate
  • Certificate III
  • Certificate II
  • Certificate I
  • Other Certificates

• a) The highest qualification that I currently hold is? (include full title of qualification, eg. Certificate III in Aged Care, VCE, IB, VCAL Intermediate,Year 10)

• b) Please indicate the number of Government subsidised courses you have commenced or are scheduled to commence in 2012?

  Select None 1 2 3 4 5 6

  • None
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• c) Please indicate the number of Government subsidised courses you are continuing in 2012?

  Select 1 2 3 4 5 6

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

• Are you from a non-English speaking background?

  Yes

  No

  N/A

• If Yes, how well do you speak English?

  Very Well

  Well

  Not Well

  Not at all

• Which of the following best describes your Employment status?

  Select (01) Full-time employee (02) Part-time employee (03) Self-employed (not employing others) (04) Employer (05) Employed - unpaid worker in a family business (06) Unemployed - seeking full-time work (07) Unemployed - seeking part-time work (08) Unemployed - not seeking employment

  • (01) Full-time employee
  • (02) Part-time employee
  • (03) Self-employed (not employing others)
  • (04) Employer
  • (05) Employed - unpaid worker in a family business
  • (06) Unemployed - seeking full-time work
  • (07) Unemployed - seeking part-time work
  • (08) Unemployed - not seeking employment

• Are you a full time student at a Secondary School?

  Yes

  No

  N/A

• What is the highest level you have Successfully COMPLETED at Secondary School?

  Select Year 12 Year 11 Year 10 Year 9 Year 8 or lower Did not go to School

  • Year 12
  • Year 11
  • Year 10
  • Year 9
  • Year 8 or lower
  • Did not go to School

• In which year did you complete that school level?

  Select 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980

  • 2012
  • 2011
  • 2010
  • 2009
  • 2008
  • 2007
  • 2006
  • 2005
  • 2004
  • 2003
  • 2002
  • 2001
  • 2000
  • 1999
  • 1998
  • 1997
  • 1996
  • 1995
  • 1994
  • 1993
  • 1992
  • 1991
  • 1990
  • 1989
  • 1988
  • 1987
  • 1986
  • 1985
  • 1984
  • 1983
  • 1982
  • 1981
  • 1980

• What was you age at January 1st 2012?

  Select 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

  • 15
  • 16
  • 17
  • 18
  • 19
  • 20
  • 21
  • 22
  • 23
  • 24
  • 25
  • 26
  • 27
  • 28
  • 29
  • 30
  • 31
  • 32
  • 33
  • 34
  • 35
  • 36
  • 37
  • 38
  • 39
  • 40
  • 41
  • 42
  • 43
  • 44
  • 45
  • 46
  • 47
  • 48
  • 49
  • 50

• What is your Victorian Student Number (VSN)? (if known)

• If you were born in another country, what year did you arrive in Australia?

• In which year did you complete the highest qualification you hold?

• Do you intend to pay for your fees via VET FEE-HELP?

  Yes

  No

  N/A

• Are you studying this course full-time or part-time?

  Full-time

  Part-time

Eligibility status for Applicants seeking a Government Subsidised Place

• Note: If seeking non-government subsidised places (eg. Short Courses, International, VETiS and FFS students) sign the enrolment authorisation part of the form. If seeking a Government subsidised place, complete the whole page and sign the enrolment authorisation.

• The student satisfied the citizenship/residency requirements (see staff declaration below) AND the address listed is in Victoria AND is currently undertaking no more than one government subsidised course (excluding Foundation level courses and, if enrolling in an apprenticeship, excluding the HSEG-specified pre-apprenticeship or pathways courses) AND has commenced or has enrolled in (but has yet to commence) no more than one government subsidised course for the first time in 2012 (excluding Foundation level courses and , if enrolling in an apprenticeship, excluding the HSEG-specified pre-apprenticeship or pathways courses) AND meets one of the following conditions (MUST TICK ONE), the student is eligible to commence a government subsidised course under the Victorian Training Guarantee.

• Student is under 20 years of age at 1 January 2012

  Yes

  No

  N/A

• Student is enrolling in a traditional apprenticeship course under an approved training contract (L funded)

  Yes

  No

  N/A

• Student is enrolling in a FOUNDATION level qualification

  Yes

  No

  N/A

• Student is enrolling in a qualification that is higher than they have declared they currently hold (note that students whose highest qualification is VCE, HSC, VCAL Intermediate or VCAL Senior must enrol in a Certificate II level or higher. Also note that qualifications achieved as part of a VETiS program are to be excluded for the purpose of this criterion)

  Yes

  No

  N/A

• The student has supplied a referral letter under the Workers in Transition Program within six months of its issue

  Yes

  No

  N/A

• If the student does not satisfy these conditions they are NOT ELIGIBLE for a government subsidised place. Discuss alternatives. If the student proceeds with an INELIGIBLE enrollment, FUND SOURCE I must be indicated on the Tick Sheet and the relevant FEE FOR SERVICE fees are to apply.

STAFF DECLARATION

• I certify that In relation to the applicant, that I have sighted the following document/s or certified copies of the document/s to determine their citizenship/residency status:

  Select An Australian Birth Certificate A current Australian Passport A current New Zealand Passport A Naturalisation Certificate A Temporary Protection Visa A Green Medicare Card A Formal document issued by the Australian Department of Immigration and Citizenship, confirming permanent residency or permission to stay in Australia indefinitely An approved referral form from the Asylum Seeker Resource Centre or Australian Red Cross

  • An Australian Birth Certificate
  • A current Australian Passport
  • A current New Zealand Passport
  • A Naturalisation Certificate
  • A Temporary Protection Visa
  • A Green Medicare Card
  • A Formal document issued by the Australian Department of Immigration and Citizenship, confirming permanent residency or permission to stay in Australia indefinitely
  • An approved referral form from the Asylum Seeker Resource Centre or Australian Red Cross

• And if the student's age on 20 January 2012, is less than 20 and the document produced from the list does not include a date of birth:

  A Current Driver's Licence

  A Current Learner's Permit

  A Proof of age card

  A Keypass card

• I have discussed the highest qualification currently held by the student and: I have made the student aware that question only refers to COMPLETED qualifications or school levels that are recognised in Australia

  Yes

  No

  N/A

• Where the student has been enrolled at KI previously, I have checked that the highest qualification is as stated:

  Yes

  No

  N/A

• I have made the student aware of the possible consequences arising from false, misleading or incomplete information:

  Yes

  No

  N/A

• I have diligently followed the process to determine the student's eligibility:

  Yes

  No

  N/A

• I have checked the enrollment form for completeness:

  Yes

  No

  N/A

• I have approved the enrolment of the student in the course/s being authorized by the Authorised Enrolling Officer's Declaration:

  Yes

  No

  N/A

• Authorised Officer:

  Sign

Privacy Statement and Student Declaration

• I agree to pay all fees and charges applicable to and arising from my enrolment and in the event of my failure to make payment, to meet the relevant legal and associated costs incurred by Kangan Insititue. I agree to abide by the policies and procedures of Kangan Institute. I have read and understood the conditions relating to fees, concessions and refunds. I authorise Kangan Institute to release information to my employer (apprentices and trainees only) and to government agencies and other parties where it is legally or contractually obliged to do so. I declare that the information I have provided is true and correct. I am aware of the consequences that may arise from providing false, misleading or incomplete information, including the cancellation of my enrolment or the withdrawal of any offer made by Kangan Institute. I understand that Kangan Institute is required to provide the Victorian Government, through Higher Education and Skills Group (HSEG), with student and training activity data which may include information I provide in this enrolment form. Information is required to be provided in accordance with the Victorian VET Student Statistical Collection Guidelines (which are available at http://www.skills.vic.gov.au/corporate/statistics/submit-data). HESG may use the information provided to it for planning, administration, policy development, program evaluation, resource allocation, reporting and/or research activities. For these and other lawful purposes, HESG may also disclose information to its consultants, advisers, other government agencies, professional bodies and/or other organizations. The Education and Training Reform Act 2006 requires Kangan Institute to collect and disclose my personal information for a number of purposes including the allocation to me of a Victorian Student Number and updating my personal information on the Victorian Student Register. I understand that I may receive a National Centre for Vocational Education Research (NCVER) survey and/or invitation to participate in a HESG endorsed project and/or be contacted by the Victorian Skills Commission (or persons authorised by the Commission) for audit purposes.

• For student eligible for VET Fee Help, the following privacy statement applies. Kangan Institute is collecting information in this form for the purpose of assessing my entitlement to Commonwealth assistance under the Higher Education Support Act 2003 and allocation of a Commonwealth Higher Education Student Support Number (CHESSN) to me. Kangan Institute will disclose this information to the Department of Industry, Innovation, Science, Research and Tertiary Education (DIISRTE) for those purposes. DIISRTE will store the information securely in the Higher Education Information Management System. DIISRTE may disclose the information to the Australian Taxation Office. Kangan Institute and DIISRTE will not otherwise disclose the information without my consent unless required or authorised by law.

• I acknowledge and agree to the terms and conditions herein.

  Sign

Customer Service Centre

• Concession type?

• Concession Reference Number? (Please attach a copy of the concession card to this form)

• Tuition Fee ($)

• Ancillary Fee ($)

• Amenities Fee ($)

• Materials Fee ($)

• Total Fees ($)

• Payment Type?

  Cash

  Visa

  MasterCard

  Cheque

  Invoice

• Invoice Number?

• Receipt Number?

• CSC Officer's Name/Stamp

  Sign

Course Details

• First Course code?

• Qualification name?

• Eligibilty met?

  Yes

  No

  N/A

• Automotive SCH?

• Second Course code?

• Qualification name?

• Eligibilty met?

  Yes

  No

  N/A

• Automotive SCH?

• Third Course code?

• Qualification name?

• Eligibilty met?

  Yes

  No

  N/A

• Automotive SCH?

Kangan Authorised Officer

• Authorising Officer, Position and Network ID?

  Sign