VSN (Victorian Student Number)

USI (Unique Student Identifier)

1. COURSE INFORMATION

(Write the name that you used when you applied for your unique student identifier (USI) , including any middle names) If you do not yet have a USI and want Hammond Institute to apply for a USI on your behalf, you must write your name, including any middle names, exactly as written in the identity document you choose to use for this purpose.

Qualification/Course Code*

Qualification/Course Name*

Delivery Mode*

Classroom-Blended
Blended
Workplace
Trainership

2. PERSONAL DETAILS

(Write the name that you used when you applied for your unique student identifier (USI) , including any middle names) If you do not yet have a USI and want Hammond Institute to apply for a USI on your behalf, you must write your name, including any middle names, exactly as written in the identity document you choose to use for this purpose.

Legal Given Name:*

Legal Family Name:*

Date of birth:*

Sex (tick on box only)

Male
Female
Indeterminate/Intersex/Unspecified

Are you a Australian Permanent Resident/ Australian Citizen/ New Zealand Citizen?

yes
No

Mobile No.:

Home No.:

Work Phone No.:

Other Contact No.:

Email Address:

3. ADDRESS

USUAL RESIDENCE What is the address location and postcode of the suburb, locality or town in which you usually live? Please provide the physical address (street number and name not post oce box) where you usually reside rather than any temporary address at which you reside for training, work or other purposes before returning to your home If you are from a rural area use the address from your state's or territory's 'rural property addressing' or 'numbering' system as your residential street address

Building/Property Name:

Flat/Unit Number:

Street Number (eg 5 or Lot 12):

Street Name:

Suburb, locality or town:

State/Territory, Postcode:

POSTAL ADDRESS

What is your postal address (if different from above?)

Building/Property Name:

Flat/Unit Number:

Street Number (eg 5 or Lot 12):

Street Name:

Suburb, locality or town:

State/Territory, Postcode:

4. EMERGENCY CONTACT DETAILS

Name:

Phone:

Relationship to you:

5. EMPLOYER DETAILS

(If applicable to the course you are applying for)

Trading Name:

Contact Name:

Address:

Phone:

6. LANGUAGE AND CULTURAL DIVERSITY

In which country were you born?

Australia

Other - please specify

No, English Only

Other - please specify Other - please specify

Are you of Aboriginal or Torres Strait Islander origin? (For persons of both Aboriginal and Torres Strait Islander origin, mark both ‘Yes’ boxes)

No
Yes, Aboriginal
Yes, Torres Strait Islander

7. DISABILITY

Do you consider yourself to have a disability, impairment or long-term condition? (No – Go to question 8)

Yes
No

If Yes, please indicate the areas of disability, impairment or long-term condition(You may indicate more than one area):

8. SCHOOLING

What is your highest COMPLETED school level? (Tick ONE box only) (Never attended school – Go to Question 9)

In which YEAR did you complete that school level?

Are you still attending secondary school?

Yes
No

9. PREVIOUS QUALIFICATION ACHIEVED

Have you SUCCESSFULLY completed any of the following qualifications?

Yes
No-If no go to question #10

If Yes, please enter one of these Prior Education Achievement Recognition Identifiers any applicable qualification level

Yes
No-If no go to question #10

If Yes, please enter one of these Prior Education Achievement Recognition Identifiers any applicable qualification level.
A – Australian E– Australian equivalent I – International

Note:

If you have multiple Prior Education Achievement Recognition Identifiers for any one qualification, use the following priority order to determine which identier to use:
1. A – Australian
2. E – Australian equivalent
3. I – International

008 - Bachelor Degree or Higher

A
E
I

410 - DegreeAdvanced Diploma or Associate

A
E
I

420 - Degree Diploma (or Associate Diploma)

A
E
I

511 - Certificate IV (or Advanced Certicate/Technician)

A
E
I

514 - Certificate III (or Trade Certicate)

A
E
I

521 - Certificate II

A
E
I

524 - Certificate I

A
E
I

990 - Certificates other than the above

A
E
I

10. EMPLOYMENT

Of the following categories, which BEST describes your current employment status? (Tick ONE box only.)

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

Which of the following classifications BEST describes your current or recent occupation?(Tick ONE box only) If never employed go to question 11.

Which of the following classifications BEST describes the industry of your current and previous employer?(Tick ONE box only) If never employed go to question 11.

11. STUDY REASON

Of the following categories, which BEST describes your main reason for undertaking this course/traineeship/apprenticeship? (Tick one box only.)

12. USI - (UNIQUE STUDENT IDENTIFIER)

From 1 January 2015, we Hammond Institute Pty Ltd can be prevented from issuing you with a nationally recognised VET qualification or statement of attainment when you complete your program if you do not have a Unique Student Identifier (USI). If you have not yet obtained a USI you can apply for it directly at http://www.usi.gov.au/create-your-USI/ on computer or mobile device.

Enter your Unique Student Identifier (If you already have one)

USI application through your RTO (if you do not already have one)

Application for Unique Student Identifier (USI)

If you would like Hammond Institute Pty Ltd to apply for a USI on your behalf,you must authorise us to do so and declare that you read the privacy information at https://www.usi.gov.au/documents/privacy-notice-when-rto-applies-their-behalf. You must also provide some additional information as noted at the end of this form so that we can apply for a USI on your behalf.

I, __________________authorise Hammond Institute Pty Ltd to apply pursuant to sub-section 9(2) of the Student Identifiers Act 2014, for a USI on my behalf.

Name

First Last

I have read and I consent to the collection, use and disclusure of my personal information which may include(sensitive information) pursuant of the information detailed at https://www.usi.gov.au/documents/privacy-notice-when-rto-applies-their-behalf and NCVER policies, procedures and protocols published on NCVER website at www.ncver.edu.au

Town/City of Birth

(Please write the name of the Australian or overseas town or city you where born). We will also need t verify your identity to create your USI.

Please ensure that the name written in 'Personal Detail' section is exactly thesame as written in the document you provide below:

Signature

Date

13. VICTORIAN STUDENT NUMBER

To be completed by all students aged up to 24 years: Since 2009 in schools and since 2011 for vocational education and training (VET) organisations and AdultCommunity Education providers, a Victorian Student Number (VSN) has been allocated upon enrolment toeach individual student aged up to 24 years. Students should report their VSN on all subsequent enrolments at a Victorian school or training organisation.In particular, all students who are currently enrolled in either a VET provider or a Victorian school (includingthose already participating in a VET in schools program) should obtain their VSN from their current educationor training organisation and report their VSN on this enrolment form. Students who are enrolling for the first time since the VSN was introduced will get a new VSN.

Enter your Victorian Student Number (VSN)

No more questions if you provided your 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.

No more questions if you answer No above.

Yes - I have attended a Victorian school since 2009 (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)

14. STUDENT ENROLMENT PRIVACY NOTICE

Victorian Government VET Student Enrolment Privacy Notice
The Victorian Government, through the Department of Education and Training (the Department), develops, monitors and funds vocational education and training (VET) in Victoria. The Victorian Government is committed to ensuring that Victorians have access to appropriate and relevant VET services. Any personal information collected by the Department for VET purposes is protected in accordance with the Privacy and Data Protection Act 2014 (Vic) and the Health Records Act 2001 (Vic).
Collection of your data
Hammond Institute Pty Ltd is required to provide the Department with student and training activity data. This includes personal information collected in the Hammond Institute Pty Ltd enrolment form and unique identifiers such as the Victorian Student Number (VSN) and the Commonwealth’s Unique Student Identier (USI).
Hammond Institute Pty Ltd provides data to the Department in accordance with the Victorian VET Student Statistical Collection Guidelines, available at: http://www.education.vic.gov.au/training/providers/rto/Pages/datacollection.aspx.
Use of your data
The Department uses student and training data, including personal information, for a range of VET purposes including administration, monitoring and planning.
A student’s USI may be used for specific VET purposes including the verification of student data provided by Hammond Institute; the administration and audit of Hammond InstituteVET providers and programs; education-related policy and research purposes; and to assist in determining eligibility for training subsidies.
Disclosure of your data
As necessary and where lawful, the Department may disclose VET data, including personal information, to its contractors,other government agencies, professional bodies and/or other organisations forVET-related purposes. In particular, this includes disclosure of VET student and training data to the Commonwealth and the National Centre for Vocational Education Research (NCVER).
Legal and Regulatory
The Department’s collection and handling of enrolment data and VSNs is authorised under the Education and Training Reform Act 2006 (Vic). The Department is also authorised to collect and handle USIs in accordance with the Student Identiers Act 2014 (Cth) and the Student Identiers Regulation 2014 (Cth).
Survey participation
You may be contacted to participate in a survey conducted by NCVER or a Department-endorsed project, audit or review relating to your training. This provides valuable feedback on the delivery of VET programs in Victoria.
Consequences of not providing your information
Failure to provide your personal information may mean that is not possible for you to enrol in VET and/or to obtain a Victorian Government VET subsidy.
Access, correction and complaints
You have the right to seek access to or correction of your personal information. You may also complain if you believe your privacy has been breached.
For further information, please contact Hammond Institute Pty Ltd’s Privacy Officer in the first instance by phone 0395336504 or email [email protected]
Further information
For further information about the way the Department collect and handles personal information,including access, corrections and complains, go to http://www.vic.gov.au/pages/privacypolicy.aspx.

15. PRIVACY STATEMENT AND STUDENT DECLARATION

Privacy Notice
Under the Data Provision Requirements 2012, Hammond Institute Pty Ltd 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 Hammond Institute Pty Ltd for statistical, regulatory and research purposes. Hammond Institute Pty Ltd 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 ortraineeship;
• 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; an
• Researchers.

Personal information disclosed to NCVER may be used or disclosed for the following purposes:
• Issuing statements of attainment or qualification, and populating authenticated VET transcripts;
• facilitating statistics and research relating to education, including surveys;
• understanding how the VET market operates, for policy, workforce planning and consumer information; and
• administering VET, including programme administration, regulation, monitoring and evaluation.

You may receive an NCVER student survey which may be administered by an NCVER employee, agent or third party contractor. 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 VET Data Policy and all NCVER policies and protocols (including those published on NCVER’s website at www.ncver.edu.au).

16. STUDENT DECLARATION

I acknowledge that I have read the Victorian Government’s VET Student Enrolment Privacy Notice.
I confirm that I have completed a pre training review session with one of Hammond Institute Pty Lts's qualified personnel before completing this Enrolment form
I declare that the information I have provided to the best of my knowledge is true and form is true and correct.
I understand that my enrolment with Hammond Institute Pty Ltd is under Skills First program may affect my future entitlement and I confirm that I feel confident that I have choosen the right course.
I have been provided with all the information regarding the qualification/course that I am enrolling in including but not limited to duration, location, mode of delivery and work placement (if applicable).
I understand it is my responsibility to read and understand the contents of the student handbook and to abide by them.
I understand and have been provided with information in relation to Credit Transfer and RPL (Recognition of Prior Learning) and that the approval of my application for credit transfer and/or RPL will affect my course duration andfees.
I agree to pay all fees and charges relating to my enrolment.
I have read and understood Hammond Institute Access and Equity Policy.
I have read and understood Hammond Institute Fee and Refund policy.
I have read and understood Hammond Institute Privacy Policy.
I have read and understood Hammond Institute Complaints and appeal policy.
I consent to the collection, use and disclosure of my personal information in accordance with Privacy Notice above.

Signature of Applicant:

Printed Name:

Date:

For applicants under 18 years of age

Parent/Guardian Signature*:

Printed Name:
*Parental/guardian consent is required for all students under the age of 18.

Date:

Disability supplement

Introduction

The purpose of the Disability supplement is to provide additional information to assist with answering the disability question.

If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:

Disability in this context does not include short-term disabling health conditions such as a fractured leg, influenza, or corrected physical conditions such as impaired vision managed by wearing glasses or lenses.

‘11 — Hearing/deaf’

Hearing impairment is used to refer to a person who has an acquired mild, moderate, severe or profound hearing loss after learning to speak, communicates orally and maximises residual hearing with the assistance of amplification. A person who is deaf has a severe or profound hearing loss from, at, or near birth and mainly relies upon vision to communicate, whether through lip reading, gestures, cued speech, finger spelling and/or sign language.

‘12 — Physical’

A physical disability affects the mobility or dexterity of a person and may include a total or partial loss of a part of the body. A physical disability may have existed since birth or may be the result of an accident, illness, or injury suffered later in life; for example, amputation, arthritis, cerebral palsy, multiple sclerosis, muscular dystrophy, paraplegia, quadriplegia or post-polio syndrome.

‘13 — Intellectual’

In general, the term ‘intellectual disability’ is used to refer to low general intellectual functioning and difficulties in adaptive behaviour, both of which conditions were manifested before the person reached the age of 18. It may result from infection before or after birth, trauma during birth, or illness.

‘14 — Learning’

A general term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self-regulatory behaviours, social perception, and social interaction may exist with learning disabilities but do not by themselves

‘15 — Mental illness’

Mental illness refers to a cluster of psychological and physiological symptoms that cause a person suffering or distress and which represent a departure from a person’s usual pattern and level of functioning.

‘16 — Acquired brain impairment’

Acquired brain impairment is injury to the brain that results in deterioration in cognitive, physical, emotional or independent functioning. Acquired brain impairment can occur as a result of trauma, hypoxia, infection, tumour, accidents, violence, substance abuse, degenerative neurological diseases or stroke. These impairments may be either temporary or permanent and cause partial or total disability or psychosocial maladjustment.

‘17 — Vision’

This covers a partial loss of sight causing difficulties in seeing, up to and including blindness. This may be present from birth or acquired as a result of disease, illness or injury.

‘18 — Medical condition’

Medical condition is a temporary or permanent condition that may be hereditary, genetically acquired or of unknown origin. The condition may not be obvious or readily identifiable, yet may be mildly or severely debilitating and result in fluctuating levels of wellness and sickness, and/or periods of hospitalisation; for example, HIV/AIDS, cancer, chronic fatigue syndrome, Crohn’s disease, cystic fibrosis, asthma or diabetes.

‘19 — Other’

A disability, impairment or long-term condition which is not suitably described by one or several disability types in combination. Autism spectrum disorders are reported under this category.

SKILLS FIRST PROGRAM

EVIDENCE OF STUDENT ELIGIBILITY AND STUDENT DECLARATION
Section A - To be completed by an authorised delegate of the Training Provider

Evidence of citizenship/residency and age

I confirm that in relation to
(Student’s full name)

I have sighted: an original; or a certified copy; or I have verified through use of a document verification service (where it is possible to do so) one of the following:
an Australian Birth Certificate (not Birth Extract)
a current Australian Passport
a current New Zealand Passport
a naturalisation certificate
a current green Medicare Card  a proxy declaration for individuals in exceptional circumstances as per Clauses 2.16 – 2.20 of these Guidelines
formal documentation issued by the Australian
Department of Immigration and Border Protection confirming permanent residence
an Australian citizenship by descent extract

OR if the individual is undertaking training under the Asylum Seeker VET Program and meets the requirements set out in Clause 17 of Schedule 1 of the VET Funding Contract, I have sighted:
a Referral Letter from the Asylum Seeker Resource Centre or the Australian Red Cross, or
for TAFE Institutes and Learn Locals organisations only, an electronic or printed record demonstrating that the student holds a current valid Bridging Visa Class E (BVE), Safe Haven Enterprise Visa (SHEV) or Temp

AND I have retained:
a copy of the original or certified copy, or
the certified copy, or
secure login access to the administrative function of a document verification service whereby a record can be viewed or extracted that confirms that the individual’s name and date of birth were verified to match a valid document number;

AND if the student’s age is relevant to their eligibility and the document produced from the list above does not include a date of birth, I have also sighted and retained a copy of:
a current drivers licence, or
a current learner permit, or
a Proof of Age card, or
a ‘Keypass’ card

NB: The Training Provider must retain a copy of all documentation used in Section A, as per Section 2 of these Guidelines.

Section B - To be completed by the student

Education history

Q1. The highest qualification I have completed is:
(Include full title of qualification, eg. Certificate III in Aged Care)

Q2. Not including the course/s you are seeking to enrol in now, how many other government funded courses have you enrolled to undertake this year? Include training you have enrolled in to undertake at this and other training
0
1
2
3
4+

Q3. Not including the course/s you are seeking to enrol in now, how many other government funded courses are you undertaking training in at the moment?
0
1
2
3
4+

Q4. In your lifetime, how many government funded courses have you started (commenced) that are at the same level as the one you are applying for now? Don’t answer this question if you are seeking to enrol in a course on the Foundation Skills List.
0
1
2
3
4+

Q5. (FOR TAFE/DUAL SECTOR ENROLMENT ONLY) If you are seeking to enrol in a course on the ‘Free TAFE for Priority Courses List’ at a TAFE or Dual Sector University, have you previously commenced a course on the ‘Free TAFE for Priority Courses List’ and received a fee waiver/exemption for that course?
Yes..........
No

I (Name)
(Student’s full name)

in seeking to enrol in
(Include full title of qualification/s in which you are seeking to enrol)

declare the following to be true and accurate statements:
a. I AM / AM NOT enrolled in a school, including government, non-government, independent, Catholic or home school.
b. I AM / AM NOT enrolled in the Commonwealth Government’s Skills for Education and Employment program.
c. I understand that my enrolment in the above qualification/s may be subsidised by the Victorian and Commonwealth Governments under the Skills First Program. I understand how enrolling in the above qualification/s will affect my future training options and eligibility for further government subsidised training under the Skills First Program.
d. I acknowledge and understand that I may be contacted by the Department or an agent to participate in a student survey, interview or other questionnaire.

Signed:

Date:

Section C - To be completed by an authorised delegate of the Training Provider

Number of courses student is currently eligible for:
1
2

Training Provider declaration

Based on discussion with the student, the above evidence I have sighted (and retained a copy of) in Section A, and the information provided to me by the student in Section B of this form I believe that the above individual satisfies the Entitlement to Funded Training eligibility criteria as set out in the VET Funding Contract and is eligible for funding under the Skill First Program for the following qualification/s

I have also sighted and retained (where applicable) relevant evidence required to grant an exemption from eligibility requirements or other limitations pursuant to any initiatives in Part C of Schedule 1 of the VET Funding Contract and as specified in Clause 2.21 of the Guidelines About Determining Student Eligibility and Supporting Evidence:

(Include full title of qualification/s in which the student is seeking to enrol)

Authorised Training Provider delegate:

Name:

Position:

Signed:

Date:

Notes Use this section to record additional, relevant eligibility information, including information used by the Training Providerto verify the individual’s eligibility that is not captured in Sections A, B or C.

Application Form

Application form

1. COURSE INFORMATION

2. PERSONAL DETAILS

3. ADDRESS

POSTAL ADDRESS

4. EMERGENCY CONTACT DETAILS

5. EMPLOYER DETAILS

6. LANGUAGE AND CULTURAL DIVERSITY

In which country were you born?

7. DISABILITY

8. SCHOOLING

9. PREVIOUS QUALIFICATION ACHIEVED

Note:

10. EMPLOYMENT

11. STUDY REASON

12. USI - (UNIQUE STUDENT IDENTIFIER)

USI application through your RTO (if you do not already have one)

Application for Unique Student Identifier (USI)

13. VICTORIAN STUDENT NUMBER

14. STUDENT ENROLMENT PRIVACY NOTICE

Victorian Government VET Student Enrolment Privacy Notice

Collection of your data

Use of your data

Disclosure of your data

Legal and Regulatory

Survey participation

Consequences of not providing your information

Access, correction and complaints

Further information

15. PRIVACY STATEMENT AND STUDENT DECLARATION

Privacy Notice

16. STUDENT DECLARATION

For applicants under 18 years of age

Disability supplement

Introduction

If you indicated the presence of a disability, impairment or long-term condition, please select the area(s) in the following list:

SKILLS FIRST PROGRAM

EVIDENCE OF STUDENT ELIGIBILITY AND STUDENT DECLARATION

Evidence of citizenship/residency and age

NB: The Training Provider must retain a copy of all documentation used in Section A, as per Section 2 of these Guidelines.

Education history

Training Provider declaration

Authorised Training Provider delegate: